Rheumatology Advance Access originally published online on May 15, 2009
Rheumatology 2009 48(7):804-806; doi:10.1093/rheumatology/kep069
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Allopurinol and mortality in hyperuricaemic patients
1Veterans Affairs Puget Sound Health Care System,2Department of Biostatistics,3Department of Epidemiology,4Department of Medicine, University of Washington, Seattle, WA, USA and 5Department of Medicine, Division of Rheumatology, University of British Columbia, Arthritis Research Centre of Canada, Vancouver, Canada.
Correspondence to: Hyon K. Choi, Department of Medicine, Division of Rheumatology, University of British Columbia, Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, BC V5Z 1L7, Canada. E-mail: hchoi{at}arthritisresearch.ca
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Abstract |
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Objectives. While studies have suggested that gout and hyperuricaemia are associated with the risk of premature death, none has investigated the role of urate-lowering therapy on this critical outcome. We examined the impact of allopurinol, the most commonly used urate-lowering drug, on the risk of mortality in hyperuricaemic patients.
Methods. From a population of hyperuricaemic veterans of [serum urate level >416 µmol/l (7.0 mg/dl)] at least 40 years of age, we compared the risk of death between incident allopurinol users (n = 2483) and non-users (n = 7441). We estimated the multivariate mortality hazard ratio (HR) of allopurinol use with Cox proportional hazards models.
Results. Of the 9924 veterans (males, 98% and mean age 62.7 years), 1021 died during the follow-up. Patients who began treatment with allopurinol had worse prognostic factors for mortality, including higher BMI and comorbidities. After adjusting for baseline urate levels, allopurinol treatment was associated with a lower risk of all-cause mortality (HR 0.78; 95% CI 0.67, 0.91). Further adjustment with other prognostic factors did not appreciably alter this estimate (HR 0.77; 95% CI 0.65, 0.91). The mean change from baseline in serum urate within the allopurinol group was –111 µmol/l (–1.86 mg/dl). Adjusting for baseline urate level, allopurinol users had a 40 µmol/l (0.68 mg/dl) lower follow-up serum urate value than controls (95% CI –0.55, –0.81).
Conclusion. Our findings indicate that allopurinol treatment may provide a survival benefit among patients with hyperuricaemia.
KEY WORDS: Allopurinol, Mortality, Hyperuricaemia, Gout
Submitted 18 December 2008;
revised version accepted 6 March 2009.
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