Treat-to-Target Urate Lowering in Patients with Gout

Guidelines advise us to lower serum urate to <6 mg/dl in patients with acute gout who begin urate-lowering therapy. In a new randomized trial, researchers compared this treat-to-target approach with a less-rigid approach in roughly 300 adults with serum urate >6 mg/dl (mean, 8.4) and histories of acute gout episodes. About 15% had subcutaneous tophi at enrollment.

In the treat-to-target group, allopurinol was started at 100 mg/day and titrated upwards every 1–2 months, targeting a serum urate level <6 mg/dl. In the randomized comparison group, decisions on starting urate-lowering therapy (and dosing) were based on “individual preferences and perceived risk.” Patients were followed for 24 months.