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The aim of this review was to summarize the evidence for combination therapy to achieve serum urate (SUA) target levels in gout. Within this overarching aim, a second aim was to evaluate the evidence for a new uricosuric agent lesinurad, which inhibits urate transport in the kidney. In summary, this review indicates that there are a number of ways to approach patients who do not achieve a target serum urate with allopurinol (APL) monotherapy. These include higher doses of APL up to 600-800 mg/d, switching to febuxostat, or adding in a uricosuric. For the latter option, controlled supporting evidence is available for benzbromarone, probenecid, and lesinurad. All options appear similar in terms of success rates, so the choice of option comes down to physician and patient choice, cost, experience, and strength of the evidence base. Increasing the dose of APL is the cheapest option, while febuxostat is consistently superior to standard doses of APL. The strongest evidence for the uricosuric option is available for lesinurad as trials of other agents are either nonexistent or based on small single-centre trials. It is suggested that guidelines should be expanded to consider all of these evidence-based options in the not-uncommon occurrence of APL inadequate response.

Item Type:	Contribution to Refereed Journal
Keywords:	gout, therapy, combination, urate lowering
Research Division:	Biomedical and Clinical Sciences
Research Group:	Clinical sciences
Research Field:	Rheumatology and arthritis
Objective Division:	Health
Objective Group:	Clinical health
Objective Field:	Clinical health not elsewhere classified
UTAS Author:	Jones, G (Professor Graeme Jones)
UTAS Author:	Panova, E (Mrs Elena Panova)
ID Code:	123935
Year Published:	2017
Web of Science® Times Cited:	10
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2018-02-01
Last Modified:	2018-12-13
Downloads:	129 View Download Statistics