Dose escalators had significantly increased all-cause mortality (hazard ratio, 1.08; 95% confidence interval, 1.01-1.17). Similar, but not statistically significant, effect sizes were seen for cardiovascular mortality (HR, 1.08; 95% CI, 0.97-1.21) and cancer mortality (HR, 1.06; 95% CI, 0.88-1.27), the investigators reported.
However, only 10% of dose-escalation patients received allopurinol in doses exceeding 300 mg daily, and only about one-third achieved a serum urate goal of less than 6.0 mg/dL after 2 years, they found.
“Patients receiving urate-lowering therapy dose escalation were only rarely escalated to levels typically required for proper gout control,” the investigators said.
Inadequate dose escalation amounts to “clinical inertia” that limited the ability of the study to show how optimal dose escalation may affect mortality, the investigators said.