A treat-to-target strategy with urate-lowering medications helps to achieve the best outcomes for all patients with gout, according to updated recommendations from the American College of Rheumatology.
The 2020 Guideline for the Management of Gout supports the use of allopurinol as a first-line agent for all patients who require urate lowering therapy, including those with chronic kidney disease. The authors suggest that clinicians move away from a fixed-dose approach, instead starting patients on a low dose and gradually raising it to a serum urate level of less than 6 mg/dL.
This strategy helps to mitigate the risk of adverse treatment effects such as hypersensitivity and the disease flares linked to drug initiation, they report.
The new guide also includes broadened recommendations for who should be given the HLA-B*5801 gene test to determine allopurinol sensitivity prior to drug initiation, said rheumatologist John FitzGerald, M.D., Ph.D., and fellow investigators.
In addition, the authors endorse the use of anti-inflammatory medications such as colchicine, NSAIDs, or prednisone/prednisolone when starting urate lowering therapy for at least three-to-six months, rather than less than three months.