Researchers Discover Why Mainline Gout Drug Is Not Effective for Many

Anyone who has experienced the excruciating pain of a gout attack is not anxious to repeat it. This is why they’re relieved to learn about allopurinol, a drug that can prevent future gout attacks.

Big Toe with Gout
The pain of a gout attack can be severe, but there are medications and dietary choices that can help prevent future attacks. Learn more: Gout Prevention

However, doctors have long known that allopurinol, which removes uric acid from the bloodstream, isn’t that effective for many who take it. In fact, in one study only 42% of participants taking allopurinol reached the target level of uric acid reduction.1

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Even though experts knew it wasn’t always effective, they didn’t know why. A new study from Clinical Pharmacology and Therapeutics seems to have figured it out: It’s genetic.2

The study examined 2,000 patients from a health plan in California who took allopurinol and had previously submitted a sample of their DNA. By comparing their DNA sequences to their uric acid test results, they were able to pinpoint one specific gene, called ABCG2, which was connected with the effectiveness of the drug.

In simple terms, a variation of this gene interferes with a protein that enables allopurinol to pass through cell walls. The researchers duplicated this process in the lab to confirm that this was the mechanism interfering with the drug’s effectiveness.

Unfortunately, there’s nothing that doctors can do to change your genes or the way they behave.

However, the researchers hope that this finding can help gout patients in the future by predicting ahead of time who is a good candidate for allopurinol via a DNA test. If results reveal you carry the gene variation that makes it less effective, your doctor could go straight to another drug alternative.

If you have gout, you can also do your part to prevent a future attack by avoiding alcohol and eating a diet low in purines, which raise uric acid levels.

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References:
  1. Becker MA, Schumacher HR, Espinoza LR, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Research & Therapy. 2010;12(2):R63. doi:10.1186/ar2978.
  2. Wen C, Yee S, Liang X, et al. Genome-wide association study identifies ABCG2 (BCRP) as an allopurinol transporter and a determinant of drug response. Clinical pharmacology and therapeutics. 2015;97(5):518-525. doi:10.1002/cpt.89.
Post written by Carrie DeVries