title: Allopurinol initiation and all-cause mortality in the general population.
abstract: BACKGROUND
  Allopurinol is the most commonly used urate-lowering therapy, with rare but potentially fatal adverse effects. However, its impact on overall mortality remains largely unknown. In this study, we evaluated the impact of allopurinol initiation on the risk of mortality among individuals with hyperuricaemia and among those with gout in the general population.
  
  
  METHODS
  We conducted an incident user cohort study with propensity score matching using a UK general population database. The study population included individuals aged ≥40 years who had a record of hyperuricaemia (serum urate level >357 μmol/L for women and >416 μmol/L for men) between January 2000 and May 2010. To closely account for potential confounders of allopurinol use and risk of death, we constructed propensity score matched cohorts of allopurinol initiators and comparators (non-initiators) within 6-month cohort accrual blocks.
  
  
  RESULTS
  Of 5927 allopurinol initiators and 5927 matched comparators, 654 and 718, respectively, died during the follow-up (mean=2.9 years). The baseline characteristics were well balanced in the two groups, including the prevalence of gout in each group (84%). Allopurinol initiation was associated with a lower risk of all-cause mortality (matched HR 0.89 (95% CI 0.80 to 0.99)). When we limited the analysis to those with gout, the corresponding HR was 0.81 (95% CI 0.70 to 0.92).
  
  
  CONCLUSIONS
  In this general population study, allopurinol initiation was associated with a modestly reduced risk of death in patients with hyperuricaemia and patients with gout. The overall benefit of allopurinol on survival may outweigh the impact of rare serious adverse effects.
authors.affiliation: Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA Rheumatology Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Dubreuil
authors.affiliation: Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Seeger
authors.affiliation: Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.affiliation: Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Young Hee
authors.initials: YH
authors.lastname: Rho
authors.affiliation: Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006073:Gout / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006074:Gout Suppressants / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D015994:Incidence; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006074:Gout Suppressants; D000493:Allopurinol
keywords: Epidemiology; Gout; Outcomes research