Research News
CMRF Funded Project Wins Prizes
Abstracts submitted by Dr Lisa Stamp for the Combined New Zealand
and Australian Rheumatology Association Annual Scientific Meeting
held in May 2009 has been awarded Best Clinical Free Paper and
Best Overall Oral Presentation.
Lisa's project "A Pilot Study of high dose allopurinol in the
management of Gout" was funded by CMRF in the
2005 Project Grant Round.
REPORT
"A Pilot Study of high dose allopurinol in the management of Gout"
“In the short/medium-term gout causes pain, suffering and time
off work and in the long term it can cause bone and joint
destruction. In order to prevent these occurring, it is important to
adequately lower serum urate. While many doctors increase the
dose of allopurinol above the recommended dosing guidelines
there is to date no prospective clinical trial examining whether this
provides further clinical benefit. There is a small amount of
retrospective data suggesting there is no increase in side effects.
This study will provide valuable information about the benefits and
risks of increasing the dose of allopurinol above the recommended guidelines.
It therefore has the potential to reduce patient suffering and time off work as well
has doctors’ visits and health care costs.”
While data analysis is still continuing an interim analysis has shown that increasing
the dose of allopurinol above recommended guidelines can successfully reduce
serum uric acid concentrations to the desired levels in the majority of patients.
There do appear to be some patients, for example patients on high doses of
diuretics for the treatment of high blood pressure or heart failure, in whom
increasing the dose of allopurinol is less successful. To date we have had no
serious adverse events associated with the use of higher than recommended doses
of allopurinol. Several patients suffered mild side effects, such as rash, which have
limited the ability to increase the dose. It would therefore appear from the interim analysis
that the outcomes we envisaged will be met.
Specific Objective
1. To demonstrate that in patients who fail to respond to the
recommended dose of allopurinol the dose of allopurinol
can be safely increased
2. To demonstrate that further increases in allopurinol dose will
be associated with a reduction in blood uric acid levels and
attacks of gout
3. To demonstrate the use of plasma oxypurinol concentrations in
guiding allopurinol dose increase
All three objectives will be met.
1. To demonstrate that in patients who fail to respond to the
recommended dose of allopurinol the dose of allopurinol can be
safely increased We have had no serious adverse events and only
a few minor side effects which have limited our ability to increase
allopurinol dose.
2. To demonstrate that further increases in allopurinol dose will be
associated with a reduction in blood uric acid levels and attacks of
gout Interim analysis shows that increasing the dose of allopurinol
above recommended guidelines results in a significant reduction in
serum uric acid. Details on attacks of gout will be known after the final
data analysis.
3. To demonstrate the use of plasma oxypurinol concentrations in
guiding allopurinol dose increase This will not be known until after
the final data analysisalthough our suspicion from the data is that
there is little role for monitoring oxypurinol concentrations, other than
to determine whether patients are taking the medicine.
