Effect of allopurinol on all-cause mortality in adults with incident gout: propensity score–matched landmark analysis

Kuo, Chang-Fu and Grainge, Matthew J. and Mallen, Christian and Zhang, Weiya and Doherty, Michael (2015) Effect of allopurinol on all-cause mortality in adults with incident gout: propensity score–matched landmark analysis. Rheumatology, 54 (12). pp. 2145-2150. ISSN 1462-0332

[img]
Preview
PDF (Supplement) - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (340kB) | Preview
[img]
Preview
PDF (Article) - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (72kB) | Preview

Abstract

Objective: To examine the association between allopurinol use and all-cause mortality for patients with incident gout.

Methods: We compared all-cause mortality in incident gout patients who received allopurinol for at least 6 months within the exposure window (1 year or 3 years) with those who did not, using the UK Clinical Practice Research Data-link. Landmark analysis was used to account for immortal time bias and propensity score matching was used to control for potential effects of known confounders.

Results: Of 23 332 incident gout patients identified, the propensity score–matched cohorts contained 1016 patients exposed to allopurinol on the date 1 year from diagnosis (landmark date) and 1016 allopurinol non-users. Over a median follow-up period of 10 years after the landmark date, there were 437 allopurinol users and 443 allopurinol non-users who died during follow-up. Allopurinol users and non-users had similar risk for all-cause mortality (hazard ratio 0.99; 95% CI 0.87, 1.12). In the 3-year landmark analysis, 3519 allopurinol users (1280 died) were compared with 3519 non-users (1265 died). The hazard ratio for all-cause mortality was 1.01 (95% CI 0.92, 1.09).

Conclusion: This propensity score–matched landmark analysis in a population of incident gout patients in the UK primary care setting found a neutral effect on the risk of all-cause mortality. Our study provides reassurance about the prescription of allopurinol for gout patients early in their disease course to prevent untoward consequences of chronic uncontrolled hyperuricaemia. However, whether higher than the commonly used dose of allopurinol could influence mortality remains to be determined.

Item Type: Article
Keywords: gout, allopurinol, mortality, propensity score, landmark analysis.
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rheumatology, Orthopaedics and Dermatology
Identification Number: 10.1093/rheumatology/kev246
Depositing User: Claringburn, Tara
Date Deposited: 08 Feb 2017 13:53
Last Modified: 11 Dec 2017 08:11
URI: http://eprints.nottingham.ac.uk/id/eprint/40401

Actions (Archive Staff Only)

Edit View Edit View