Gout Flare Common Following Allopurinol Discontinuation

Artem Minalyan, MD

Gout flare is almost 14-times more likely to develop in hospitalized patients who have allopurinol discontinued upon admission compared to those who have the treatment continued, according to new study findings.

The findings, presented at the 14th Annual North American Young Rheumatology Investigator Forum, emphasized the importance of medication reconciliation when caring for hospitalized patients.

Artem Minalyan, MD, and colleagues from the Department of Medicine at Abington Hospital-Jefferson Health, conducted a retrospective study of patients with a history of gout, on chronic urate-lowering therapy with allopurinol, and were admitted to the hospital for conditions other than gout. Patients included were hospitalized for at least 2 days. The investigators reviewed charts for patient demographics, length of stay, discontinuation of allopurinol, gout flare, and corresponding risk factors.

Overall, the team included 401 patients with a history of gout who used allopurinol as an outpatient medication. The mean age of those included was 75±13 years old (range, 40-99 years old). Most of the patients were males (74%) and the mean length of stay was 6.29 days (range, 2-57 days). A majority of the patients were obese with a mean body mass index (BMI) of 30 kg/m2. The allopurinol and no allopurinol groups did not have significantly different baseline characteristics, including age, gender, length of stay, BMI, use of loop and thiazide diuretics, history of renal failure, and smoking status.

Among the patients who discontinued allopurinol on admission, 23.3% developed gout flare during hospitalization. Only 2.2% of patients who continued allopurinol developed gout flare during hospitalization. There were significantly higher odds of having gout flare in the no allopurinol group than among those who received allopurinol (Fisher exact probability test OR, 13.8; 95% CI, 4.6-41.4; P <.0001).

It has previously been reported that discontinuation of urate-lowering therapy in the outpatient setting increases the risk of gout flare. In fact, previous research has demonstrated allopurinol was discontinued or decreased on the day of admission in almost a quarter of hospital admissions in patients with gout flare.

Minalyan and the team replicated such findings, proving hospitalized patients who had allopurinol discontinued upon admission were almost 14-times more likely to develop gout flare than those who had allopurinol continued. The investigators reported the importance of medication reconciliations when providing care to hospitalized patients. Further, they noted the need to understand the role of continuation of urate-lowering therapy in the inpatient setting to decrease the risk of gout flare in hospitalized patients.

The study, “The discontinuation of allopurinol in the inpatient setting and the risk of gout flare: A Community Experience,” was presented at the North American Young Rheumatology Investigator Forum.