Article Figures & Data
Figures
- Figure 1.
Site of action of different urate-lowering therapies. XO: xanthine oxidase.
- Figure 2.
The therapeutic chain. Darker boxes represent the main sources that affect allopurinol success or failure.
- Figure 3.
Percentage of participants achieving target SU stratified by oxypurinol concentration following allopurinol dose escalation using a treat to SU target approach over 24 months (data taken from previous studies18,19). Patients with SU ≥ 0.36 mmol/L and < 100 µmol/L are the true nonresponders. Oxy: oxypurinol; SU: serum urate.
Tables
ACR: American College of Rheumatology; BSR: British Society of Rheumatology; CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; EULAR: European Alliance of Associations for Rheumatology; FBX: febuxostat; FDA: US Food and Drug Administration; QOL: quality of life; SU: serum urate; ULT: urate-lowering therapy; XOI: xanthine oxidase inhibitor.
Cause Reasons Action Required Failure to control SU Inadequately dosed, taking regularly Increase allopurinol dose Adequately dosed, taking regularly Check source of allopurinol to confirm not counterfeit
Add or switch to another ULTNot taking regularly Review and address barriers to allopurinol adherence/
persistence, before further dose escalation, adding
additional medications, or switching ULTFailure to control clinical symptoms
despite SU controlIncorrect diagnosis Review diagnosis Correct diagnosis, gout flares occurring early in the
course of treatmentContinue allopurinol at the dose that controls SU, plus
add flare prophylaxis and action plan for flareCorrect diagnosis, high MSU crystal burden and SU
at standard targetMay need lower SU target: increase allopurinol dose
further or add/switch to another ULTFailure due to adverse drug reaction
to allopurinolMedication intolerance Switch to another ULT MSU: monosodium urate; SU: serum urate; ULT: urate-lowering therapy.
In this issue
Jump to section
- Article
- Abstract
- Currently available ULTs and rank order for use
- What do allopurinol success and failure look like?
- Failure of allopurinol to achieve target SU
- Failure to achieve the desired clinical outcomes despite reducing the SU to target
- Adverse reaction requiring cessation of allopurinol
- What is the approach to allopurinol failure?
- Conclusion
- Footnotes
- REFERENCES
- Figures & Data
- Info & Metrics
- References