Official Title

Does Allopurinol Prolong a Treated, Acute Gout Flare?
  • Phase

    Phase 4
  • Study Type

    Interventional
  • Indication/Condition

    Gout
  • Intervention/Treatment

    allopurinol ...
  • Study Participants

    35
This is a double blind placebo controlled study to determine whether starting allopurinol during a treated acute gout attack will have any effect on the duration of the attack.
Traditional teaching holds that starting allopurinol during an acute gout attack will prolong the attack. Recent expert opinion from the American College of Rheumatology Guidelines is that allopurinol may be started during an acute, treated gout attack. This study is designed to test the hypothesis that allopurinol does not prolong an acute, treated gout attack. Patients will either take allopurinol capsules or and identical capsule containing no allopurinol (placebo) over 28 days, starting within 72 hours of a gout attack that is being treated with other standard measures. During the study, neither the patient nor the examiner will know what pills are being taken. The time to resolution of the attack is the primary outcome measure. Pain level, serum uric acid level, and complications of therapy will also be monitored. A minimum of 32 patients completing the study are needed for a meaningful conclusion.
Study Started
Dec 31
2007
Primary Completion
Jun 30
2013
Study Completion
Jun 30
2013
Results Posted
Jan 05
2015
Estimate
Last Update
Feb 14
2018

Drug allopurinol

Drug Placebo (sugar pill)

Allopurinol Active Comparator

Patients in this arm receive allopurinol, 100 mg daily for 14 days and then 200 mg daily for 14 days

Sugar pill (Placebo) Placebo Comparator

Patients in this arm receive one placebo (sugar) pill per day for 14 days then 2 placebo pills for 14 days.

Criteria

Inclusion Criteria requires both of:

Crystal proven gout, and
An acute gout attack within 72 hours of first treatment

Plus one of the following:

At least 2 gout attacks in past 12 months
Tophus
Nephrolithiasis
24hr urine uric acid greater than 1000mg

Exclusion Criteria:

Inability to return for examinations
Glomerular filtration rate (calculated) less than 50 milliliters per minute
Allopurinol use in past 6 months
Ongoing cancer therapy
Concomitant azathioprine or cyclophosphamide

Any one of the following liver enzymes greater than 1.25 times the upper limit of normal:

AST [Aspartate aminotransferase]
ALT [Alanine aminotransferase]
alkaline phosphatase
Pre-gout pain in involved joint of more than 3 on a scale of 1-10
Neurologic deficit around the involved joint

Summary

Allopurinol

Sugar Pill (Placebo)

All Events

Event Type Organ System Event Term Allopurinol Sugar Pill (Placebo)

Resolution of the Acute Gout Attack

The primary outcome unit of measurement is time (in days) to resolution of the acute gout attack

Allopurinol

15.4
days (Mean)
Standard Deviation: 7.9

Sugar Pill (Placebo)

13.4
days (Mean)
Standard Deviation: 7.8

Pain Day 28

Patient rated pain on a Likert pain score of 0-10

Allopurinol

1.79
units on a Likert scale (Mean)
95% Confidence Interval: 0.0 to 4.0

Sugar Pill (Placebo)

2.0
units on a Likert scale (Mean)
95% Confidence Interval: 0.0 to 4.0

Physician Global Assessment of Gout Activity at Day 28

Physician rated gout activity is measured on a Likert scale 0-10.

Allopurinol

Sugar Pill (Placebo)

Serum Uric Acid Level

Blood test (serum) for uric acid level

Allopurinol

6.4
mg/dl (Mean)
Standard Error: 1.0

Sugar Pill (Placebo)

8.2
mg/dl (Mean)
Standard Error: 1.0

Total

35
Participants

Age, Continuous

57
Years (Mean)
Full Range: 31.0 to 84.0

Disease duration

5.2
years (Mean)
Full Range: 0.0 to 20.0

number of prior attacks

5.2
number (Mean)
Full Range: 0.0 to 35.0

Participants with erosions

8
participants

participants with history of nephrolithiasis

5
participants

participants with tophi

12
participants

Sex: Female, Male

Overall Study

Allopurinol

Sugar Pill (Placebo)

Drop/Withdrawal Reasons

Allopurinol

Sugar Pill (Placebo)