ReviewSeminars in arthritis and rheumatism2014
Impaired response or insufficient dosage? Examining the potential causes of "inadequate response" to allopurinol in the treatment of gout.
Review in Seminars in arthritis and rheumatism, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 62 citations in OpenAlex.
- A systematic review of single nucleotide polymorphisms affecting allopurinol pharmacokinetics and serum uric acid level.Pharmacogenomics · 2024Pooled it
- [Full version of the S2e guidelines on gouty arthritis : Evidence-based guidelines of the German Society of Rheumatology (DGRh)].Zeitschrift fur Rheumatologie · 2016Guideline
- Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial.The American journal of medicine · 2019Trial
- Effectiveness of an electronic patient-centred self-management tool for gout sufferers: a cluster randomised controlled trial protocol.BMJ open · 2017Trial
- Evaluation of ChatGPT-4o and Gemini for gout management: a comparative analysis based on EULAR guidelines.Scientific reports · 2026Article
- Article
- Clinical Practice Consensus Statement 2025: Management of Hyperuricemia and Gout in Adolescents.International journal of rheumatic diseases · 2025Article
- Enhanced and Sustained Transdermal Delivery of Oxypurinol Using Thermosensitive Gel Combined with Polymeric Solid Microneedles.ACS omega · 2025Article
- The genetics of gout: translation into clinical practice.Therapeutic advances in musculoskeletal disease · 2025Review
- Effect of Theme-Based Nursing Education on Disease Awareness, Serum Uric Acid Control, Quality of Life, and Acute Attacks in Patients with Gout: A Randomized Controlled Study at a Tertiary Hospital in Beijing.Patient preference and adherence · 2025Article
- Association of rare and common genetic variants in MOCOS with inadequate response to allopurinol.Rheumatology (Oxford, England) · 2024Article
- Integrated Microbiome and Metabolome Analysis Reveals Hypothalamic-Comorbidities Related Signatures in Craniopharyngioma.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2024Article
- Psychometric evaluation of the Adherence to Refills and Medications Scale (ARMS) in Australians living with gout.Clinical rheumatology · 2024Article
- A Genome-Wide Association Study of Oxypurinol Concentrations in Patients Treated with Allopurinol.Journal of personalized medicine · 2024Article
- Population pharmacokinetic modelling of febuxostat in healthy subjects and people with gout.British journal of clinical pharmacology · 2022Article
- Comparative Effectiveness of Allopurinol and Febuxostat in Gout Management.NEJM evidence · 2022Article
- Genome-Wide Association and Functional Studies Reveal Novel Pharmacological Mechanisms for Allopurinol.Clinical pharmacology and therapeutics · 2019Article
- The Role of a "Treat-to-Target" Approach in the Long-Term Renal Outcomes of Patients with Gout.Journal of clinical medicine · 2019Article
- Moving the Needle: Improving the Care of the Gout Patient.Rheumatology and therapy · 2019Review
- An update on the genetics of hyperuricaemia and gout.Nature reviews. Rheumatology · 2018Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
objectivesGout is one of the most common forms of arthritis. It is well established that urate-lowering therapy that aims for a serum urate less than at least 0.36 mmol/l (6 mg/dl) is required for the successful management of gout. Allopurinol, a xanthine oxidase (XO) inhibitor, is the most commonly used urate-lowering therapy. However, many patients fail to achieve the target serum urate on allopurinol; these patients can be considered to have "inadequate response" to allopurinol. Herein, we examine the potential mechanisms and implications of inadequate response to allopurinol.
methodsThe literature was reviewed for potential causes for failure to reach target serum urate in patients receiving allopurinol.
resultsThe two most common causes of inadequate response to allopurinol are poor adherence and under-dosing of allopurinol. Adherent patients who fail to achieve target serum urate on standard doses of allopurinol form a group that could be considered to be "partially resistant" to allopurinol. There are four potential mechanisms for partial allopurinol resistance: decreased conversion of allopurinol to oxypurinol; increased renal excretion of oxypurinol; abnormality in XO structure and/or function such that oxypurinol is rendered less effective and/or drug interactions.
conclusionsIt is important to determine the reasons for failure to achieve treatment targets with allopurinol, particularly as newer agents become available. The knowledge of the mechanisms for inadequate response may help guide the clinician towards making a therapeutic choice that is more likely to result in achieving the serum urate target.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.