Friday, 22 Mar 2019

You are here

Risk of Gout Onset and Flare Linked to Urate Levels

Serum uric acid (SUA) levels are clearly linked to gout. Researchers from Harvard have systemically reviewed the literature to quantify the risk of onset and flare with varying levels of SUA.

Literature review identified 8 eligible articles reporting gout incidence and 18 articles reporting recurrent gout rates in the context of SUA levels.

Gout incidence rates per 1000 person-years from population-based studies ranged from 0.8 (SUA ≤ 6 mg/dl) to 70.2 cases (SUA ≥ 10 mg/dl).

Recurrent gout risk in clinical cohorts ranged from 12% (SUA ≤ 6 mg/dl) to 61% (SUA ≥ 9 mg/dl) among those receiving urate-lowering therapy (ULT), and for those controlled with successful ULT, flare/recurrence rates ranged from 3.7% (SUA 6-7 mg/dl) to 61% (SUA > 9.3 mg/dl).

These data on the risks of higher SUA levels and gout underscores the need to treat to SUA targets as recommended by the American College of Rheumatology and the European League Against Rheumatism.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Ironwood Retreats from the US Gout Market

Ironwood Pharmaceuticals discontinued the marketing and sales of both lesinurad (Zurampic) the combination drug of lesinurad and allopurinol (Duzallo) in the United States effective February 1, 2019. In addition the Duzallo and Zurampic Patient Savings Program were also discontinued on December 31, 2018.

The company stated that this was a financial decision unrelated to the efficacy or safety of lesinurad.

Allopurinol Reduces Cardiovascular Outcomes in Diabetes

A Canadian study has shown that elderly diabetics who take allopurinol have a significant reduction in cardiovascular outcomes.  

Hyperuricemia has been shown to be a biomarker for cardiovascular outcomes in multiple disorders. These investigators studied the effect of allopurinol and mortality on CV outcomes in a population-based retrospective cohort study from Ontario, Canada.

FDA Slaps a Boxed Warning on Febuxostat for CV Risk

The U.S. Food and Drug Administration (FDA) has reviewed data from the Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) trial and concluded there is an increased risk of death with Uloric (febuxostat) compared with allopurinol, and has added this as a boxed warning to the drug’s product label.

U.S. Gout Rates Remain Steady, but Substantial

Using data from 5,467 adults in the US in the National Health and Nutrition Examination Survey (NHANES) for the years 2007-2016, researchers found that the prevalence of gout and hyperuricemia has remained at 3.9%, having doubled from the 1960s to the 1990s, corresponding to an estimated 9.2 million adults with gout in 2015-2016.

Febuxostat Gets Reprieve from FDA Advisory Panel

On January 11, 2019 the FDA convened two advisory panels (the Arthritis Advisory Committee [AAC] and the Drug Safety and Risk Management Advisory Committee [DSaRM]) to consider the cardiovascular safety of febuxostat (Uloric) based on the 2018 “Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) study. 

The Vote