Ann Rheum Dis doi:10.1136/annrheumdis-2014-205269
  • Clinical and epidemiological research
  • Extended report

Allopurinol initiation and all-cause mortality in the general population

  1. Hyon K Choi1,3
  1. 1Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Rheumatology Division, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
  3. 3Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  4. 4Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Maureen Dubreuil, Instructor of Medicine, Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine, 650 Albany Street Suite 200, Boston, MA 02118, USA; maureen.dubreuil{at}
  • Received 21 January 2014
  • Revised 21 February 2014
  • Accepted 1 March 2014
  • Published Online First 24 March 2014


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.