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Serum uric acid–lowering, generally to <6 mg/dL, is critical in managing patients with gout. The FDA has approved allopurinol, the most commonly used urate-lowering therapy, for dosing as high as 800 mg daily, but most prescriptions don't exceed 300 mg daily, partly because of safety concerns. To assess the safety and urate-lowering efficacy of dose escalation, researchers in New Zealand enrolled 183 gout patients (mean age, 60; mean baseline serum urate level, 7.2 mg/dL; 52% with creatinine clearance [CrCl] <60 mL/minute and 13% with CrCl <30 mL/minute) who had been receiving CrCl-based allopurinol doses for ≥1 month. Participants were randomized to continue allopurinol at their current doses (control group; mean baseline dose, 276 mg dail…