Benefits and risks of allopurinol prescription in asymptomatic hyperuricemia in prevention of first gout attack, cardiovascular and renal events

Introduction: A study seeking to produce of a list of 5 procedures of care frequently prescribed in family practice in despite a negative balance between benefits and risks is currently in progress in France. Allopurinol in asymptomatic hyperuricemia is one of the care procedures eligible for this "Top five list". Objective: To evaluate the benefits and risks of allopurinol in asymptomatic hyperuricemia and then to synthesize the data from scientific literature in the form of a guide for general practitioners investigating the "top five list". Methods: Literature review using Medline, Embase, Cochrane Library and grey literature databases. Data on the efficacy and safety of allopurinol in preventing a first gout attack in healthy patients with asymptomatic hyperuricemia were investigated. Study quality (original articles, literature reviews and meta-analyses) was assessed to select only the most robust data for the development of the guide. Results: Out of 5105 articles, no studies have been found on allopurinol in asymptomatic hyperuricemia to prevent first gout attack. After expanding the inclusion criteria, one randomized trial was included. This poor quality randomized trial showed a significant decrease of systolic blood pressure and a significant improvement of renal function. For adverse events, the search criteria had to be extended again to non-healthy patients. Taking allopurinol exposes 1 in 11 treated patients to adverse reactions. Conclusion: Current scientific data do not support the prescription of allopurinol in asymptomatic hyperuricemia. The synthetic guide resulting from this research will allow the general practitioners of the study to choose their "top five list".