Allopurinol and mortality in hyperuricaemic patients

Methods. From a population of hyperuricaemic veterans of [serum urate level 416 mol/l (7.0 mg/dl)] at least 40 years of age, we compared the risk of death between incident allopurinol users (n 2483) and non-users (n 7441). We estimated the multivariate mortality hazard ratio (HR) of allopurinol use with Cox proportional hazards models. Results. Of the 9924 veterans (males, 98 and mean age 62.7 years), 1021 died during the follow-up. Patients who began treatment with allopurinol had worse prognostic factors for mortality, including higher BMI and comorbidities. After adjusting for baseline urate levels, allopurinol treatment was associated with a lower risk of all-cause mortality (HR 0.78; 95 CI 0.67, 0.91). Further adjustment with other prognostic factors did not appreciably alter this estimate (HR 0.77; 95 CI 0.65, 0.91). The mean change from baseline in serum urate within the allopurinol group was 111 mol/l (1.86 mg/dl). Adjusting for baseline urate level, allopurinol users had a 40 mol/l (0.68 mg/dl) lower follow-up serum urate value than controls (95 CI 0.55, 0.81). Conclusion. Our findings indicate that allopurinol treatment may provide a survival benefit among patients with hyperuricaemia.