Hay, CA ORCID: https://orcid.org/0000-0003-3496-7044, Prior, JA ORCID: https://orcid.org/0000-0001-9213-2796, Belcher, J, Mallen, CD ORCID: https://orcid.org/0000-0002-2677-1028 and Roddy, E ORCID: https://orcid.org/0000-0001-8699-0735 (2020) Mortality in patients with gout treated with allopurinol: a systematic review and meta-analysis. Arthritis Care Res (Hoboken).

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Abstract

BACKGROUND: Urate-lowering therapy (predominantly allopurinol) is highly effective as a treatment for gout, but its wider long-term effects remain unclear. This systematic review and meta-analysis aimed to ascertain the association between allopurinol use in patients with gout and mortality. METHOD: MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched from inception to August 2018. Articles eligible for inclusion used a cohort design and examined cardiovascular or all-cause mortality in patients diagnosed with gout and prescribed allopurinol. Information on study characteristics, design, sample size and mortality risk estimates were extracted. Article quality was assessed using the Newcastle-Ottawa Scale. Included articles were described in a narrative synthesis and (where possible) risk estimate data were pooled. RESULTS: Four articles reported a hazard ratio (HR) risk estimate for all-cause mortality in patients with gout using allopurinol, two of these also reported cardiovascular mortality. Two articles found allopurinol to be protective in patients with gout, one found no statistically significant association and one found no statistically significant effect of escalation of allopurinol dosage on all-cause or cardiovascular-related mortality. Data pooling was possible for all-cause mortality and found no association between allopurinol use in patients with gout and all-cause mortality compared to patients with gout not using allopurinol (adjusted HR 0.80 (95%CI (0.60, 1.05). CONCLUSIONS: There was no significant association between all-cause mortality and allopurinol use in people with gout. However, the number of included studies was small, suggesting that further studies are needed.

Item Type: Article
Additional Information: © 2020 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Uncontrolled Keywords: Gout; allopurinol; mortality; inflammatory arthritis; primary care; systematic review
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 30 Apr 2020 11:51
Last Modified: 11 Jun 2020 10:37
URI: https://eprints.keele.ac.uk/id/eprint/7913

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