Preventing treatment inertia: 2020 ACR Guidelines discuss that ULT titration should occur over weeks to months, not years3
Uptitrating oral ULTs oftentimes yields diminishing returns1
This can be explained in 2 ways:
- 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
- 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.
- Becker MA, et al. Semin Arthritis Rheum. 2015;45(2):174-183.
- Schumacher HR Jr, et al. Arthritis Rheum. 2008;59(11):1540-1548.
- FitzGerald JD, et al. Arthritis Care Res (Hoboken). 2020;72(6):744-760.
- Graham G, et al. Br J Clin Pharmacol. 2013;76(6):932-938.