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A chart showing proportion of patients with sUA <6.0 mg/dL categorized by their final daily allopurinol dose, with 17.9% of patients receiving 0-100 mg (n=39), 33.8% of patients receiving >100-200 mg (n=216), 43% of patients receiving >200-300 mg (n=1115), 56.6% of patients receiving >300-400 mg (n=196), 58% of patients receiving >400-500 mg (n=69), 44.2% of patients receiving >500-600 mg (n=43), and 36.8% of patients receiving >600 mg (n=19) achieving sUA <6.0A chart showing proportion of patients with sUA <6.0 mg/dL categorized by their final daily allopurinol dose, with 17.9% of patients receiving 0-100 mg (n=39), 33.8% of patients receiving >100-200 mg (n=216), 43% of patients receiving >200-300 mg (n=1115), 56.6% of patients receiving >300-400 mg (n=196), 58% of patients receiving >400-500 mg (n=69), 44.2% of patients receiving >500-600 mg (n=43), and 36.8% of patients receiving >600 mg (n=19) achieving sUA <6.0

Preventing treatment inertia: 2020 ACR Guidelines discuss that ULT titration should occur over weeks to months, not years3

A graphic showing how xanthine oxidase inhibitors may be limited in effectiveness when xanthine oxidase is saturated

Uptitrating oral ULTs oftentimes yields diminishing returns1

This can be explained in 2 ways:

Enzyme Limitations

  • Once xanthine oxidase (XO) in the body has been saturated, increasing the dose of xanthine oxidase inhibitors (XOIs) is unlikely to have any additional effect on uric acid metabolism4

Existing Burden

  • While XOIs can limit the production of uric acid, they do not actively remove saturated urate from the body4
  • XOIs, by their mechanism, do not actively address uric acid that has already been produced4

sUA, serum uric acid; ULT, urate-lowering therapy.

References

  1. Becker MA, et al. Semin Arthritis Rheum. 2015;45(2):174-183.
  2. Schumacher HR Jr, et al. Arthritis Rheum. 2008;59(11):1540-1548.
  3. FitzGerald JD, et al. Arthritis Care Res (Hoboken). 2020;72(6):744-760.
  4. Graham G, et al. Br J Clin Pharmacol. 2013;76(6):932-938.