Allopurinol Versus Rilonacept for the Prevention of Gout Flares: Comment on the Article by Schumacher et al


To the Editor:

I read with great interest the article by Schumacher et al published recently in Arthritis Care & Research (1). It seems ironic that this article followed the American College of Rheumatology guidelines for the management of gout (2). The study by Schumacher et al compared rilonacept with placebo in patients initiating treatment for gout with allopurinol 300 mg daily. The American College of Rheumatology guidelines suggest starting allopurinol 100 mg daily and then titrating the dose every 2–5 weeks until the optimum dose is achieved. The reason given in the guideline article was that this lower starting dose could reduce early gout flares. Unfortunately, those advocating for the use of rilonacept (a new and I am sure expensive therapy) to prevent gout flares make this very claim. We do not know (and may never know) if a slow titration of allopurinol as suggested in the guidelines would have resulted in a comparable number of gout flares as treatment with rilonacept. All rheumatologists and health professionals would like to spare our patients the pain and suffering of a gout attack; however, we may never know if a new and expensive approach to starting allopurinol is even needed.

Michele Meltzer MD, MBE*, * Thomas Jefferson University, Philadelphia, PA.