Gout Guidelines Recommend Allopurinol as First-Line Treatment

By Kelly Young

Edited by Richard Saitz, MD, MPH, FACP, DFASAM

Allopurinol is now the sole recommended first-line treatment for managing gout — owing to treatment costs and cardiovascular concerns about febuxostat — according to updated guidelines from the American College of Rheumatology. Allopurinol is strongly recommended for all patients, including those with stage 3 and above chronic kidney disease.

In its 2012 guidelines, the group had also recommended febuxostat as a first-line agent. Now, patients with a new cardiovascular disease (CVD) event or a history of CVD events should consider switching from febuxostat, as it has been associated with a higher risk for CVD mortality. Either febuxostat or allopurinol is still recommended over probenecid for patients with moderate-to-severe chronic kidney disease.

The guidelines recommend a treat-to-target approach, with a serum urate goal of under 6 mg/dL.

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