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Use of urate-lowering therapies is not associated with an increase in the risk of incident dementia in older adults
  1. Jasvinder A Singh1,2,3,
  2. John D Cleveland2
  1. 1Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
  2. 2Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Division of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Jasvinder A Singh, University of Alabama, Birmingham, Alabama, USA; jasvinder.md{at}gmail.com

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Few recent studies1–3 reported that hyperuricemia may be protective against dementia, a common disease in the elderly associated with significant morbidity and mortality.4 5 We hypothesised that allopurinol or febuxostat use (the two most common urate-lowering therapies (ULTs)) in the elderly will be associated with a higher risk of dementia.

Study methods for this new user design study (a more robust design than a prevalent user design) were similar to those previously reported.6 Patients were eligible for this retrospective cohort study if they were (1) US residents enrolled in Medicare fee-for-service (covers all Americans ≥65 years) with pharmacy coverage, ie, enrolled in Medicare parts A (inpatient care), B (outpatient doctor and laboratory service) and D (prescription drugs) and not enrolled in a Medicare Advantage Plan (a standard approach for analysis)7 during 2006–2012 and (2) filled a new allopurinol (or febuxostat) prescription with a clean baseline period of 365 days with no exposure to either drug. Incident dementia was identified by new occurrence (no diagnosis in the 183-day baseline period) of an International Classification of Diseases, 9th Revision code, 290.xx, 294.1x or 331.2, a valid approach for dementia studies.8 9 We followed each eligible patient until the loss of Medicare coverage, dementia, death or the end of the study period, whichever came first. We used multivariable-adjusted Cox proportional …

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