Start-Low Go-Slow Dose Escalation of Allopurinol

Anti-inflammatory prophylaxis when starting allopurinol using the “start-low go-slow” dose escalation strategy could potentially be better targeted at those who have had a gout flare within the month before starting allopurinol and when commencing allopurinol at 100 mg daily, according to a study published in Arthritis Care & Research.

The objective of the study was to identify predictors of gout flares when initiating allopurinol using the “start-low go-slow” dose escalation strategy. The study was a post hoc analysis of a 12-month double-blind, placebo-controlled, noninferiority trial. Participants were randomized 1:1 to receive either colchicine 0.5 mg daily or a placebo for the first 6 months. Multivariate logistic regression models were utilized to identify independent predictors of gout flares during the first and last 6 months of the trial.

The results showed that, in the first 6 months, significant predictors of gout flares included experiencing a flare in the month before starting allopurinol (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.36–5.17) and beginning treatment with an allopurinol 100 mg dose (OR 3.21, 95% CI 1.41–7.27). In the last 6 months of the trial, after discontinuing colchicine or placebo, predictors of gout flares included having received colchicine (OR 2.95, 95% CI 1.48–5.86), experiencing at least 1 flare in the month before stopping the study drug (OR 5.39, 95% CI 2.21–13.15), and having a serum urate level of ≥0.36 mmol/L at month 6 (OR 2.85, 95% CI 1.14–7.12).

“For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required,” the authors concluded.

Reference
Stamp LK, Horne A, Mihov B, et al. Predicting gout flares in people starting allopurinol using the start-low go-slow dose escalation strategy. Arthritis Care Res (Hoboken). Published online May 20, 2024. doi:10.1002/acr.25376