A randomised controlled trial on the efficacy and tolerability with dose escalation of allopurinol 300-600 mg/day versus benzbromarone 100-200 mg/day in patients with gout

OBJECTIVES

To compare the efficacy and tolerability of allopurinol 300-600 mg/day versus benzbromarone 100-200 mg/day used to attain a target serum urate concentration (sUr) < or =0.30 mmol/l (5 mg/dl).

METHODS

A randomised, controlled, open-label, multicentre trial in gout patients with renal function defined as a calculated creatinine clearance > or =50 ml/min. Patients were treated with 300 mg allopurinol or 100 mg benzbromarone once a day (stage 1). If sUr < or =0.30 mmol/l was not attained after 2 months, the dose was doubled to allopurinol 300 mg twice a day or benzbromarone 200 mg once a day (stage 2). The primary end point was treatment success in either of the two stages, defined as clinical tolerability and attainment of biochemical target sUr.

RESULTS

Sixty-five patients were enrolled in stage 1; 36 received allopurinol and 29 received benzbromarone. Fifty-five patients (85%) were analysed at stage 1: the success rates were 8/31 (26%) and 13/25 (52%), respectively, and the difference was -0.26 (95% CI from -0.486 to -0.005), p = 0.049. At stage 2, the success rates were 21/27 (78%) and 18/23 (78%), respectively, and the difference was -0.005 (95% CI from -0.223 to 0.220), p = 1.00. Two patients stopped receiving allopurinol and three stopped receiving benzbromarone because of adverse drug reactions.

CONCLUSIONS

Increasing the allopurinol dose from 300 to 600 mg/day and the benzbromarone dose from 100 to 200 mg/day according to the target sUr produced significantly higher success rates (both 78% successful in attaining sUr < or =0.30 mmol/l). No significant differences in treatment success between benzbromarone and allopurinol were found after dose escalation.

TRIAL REGISTRATION NUMBER

ISRCTN49563848).

Efficacy and tolerability of urate-lowering drugs in gout: a randomised controlled trial of benzbromarone versus probenecid after failure of allopurinol

OBJECTIVES

To investigate the efficacy and tolerability of allopurinol as the first-choice antihyperuricaemic treatment for gout, and compare the efficacy and tolerability of benzbromarone and probenecid as second-choice treatment.

METHODS

Prospective, multicentre, open-label, two-stage randomised controlled trial in gout patients with normal renal function. Enrolled patients were given 300 mg allopurinol for 2 months (stage 1). Those patients who could not tolerate allopurinol or who did not attain the target serum urate concentration (sUr) < or=0.30 mmol/l (5.0 mg/dl), which was defined as successful, were randomised to benzbromarone 200 mg/day or probenecid 2 g/day for another 2 months (stage 2).

RESULTS

96 patients were enrolled in stage 1. 82 patients (85%) were eligible for the analysis at the end of stage 1: there was a mean (SD) decrease in sUr concentration of 35 (11)% from baseline; 20 patients (24%) attained target sUr < or=0.30 mmol/l; and 9 patients (11%) stopped allopurinol because of adverse drug reactions. 62 patients were enrolled in stage 2. 27 patients received benzbromarone (3 patients not eligible for analysis) and 35 received probenecid (4 patients not eligible for analysis). Treatment with benzbromarone was successful in 22/24 patients (92%) and with probenecid in 20/31 patients (65%) (p = 0.03 compared with benzbromarone). Compared with baseline values, there was a mean (SD) decrease of sUr concentration of 64 (9)% with benzbromarone and 50 (7)% with probenecid (p<0.001).

CONCLUSION

This study showed that allopurinol 300 mg/day has a poor efficacy and tolerability profile when used to attain a biochemical predefined target level of sUr < or =0.30 mmol/l, following 2 months of treatment. In stage 2, benzbromarone 200 mg/day was more effective and better tolerated than probenecid 2 g/day.

Thermostatic and dynamic performance of an ultrasonic density probe

The thermally static and dynamic performance of an ultrasonic density probe for liquids is investigated in the density range of 750 to 1300 kg/m3 at temperature ranging from 0 to 40 degrees C. The single transducer probe uses a pulse echo technique to obtain the characteristic acoustic impedance of the liquid and, subsequently, the speed of sound through the liquid to obtain the density of the liquid. Variations in the initial sound amplitude are addressed by the design of a layered two material probe. It is shown that it is possible to obtain an accuracy of 0.4% in the experiments carried out. For changing temperature, the probe exhibits large errors because of problems in estimating the temperatures in certain regions of the probe.

PSpice simulation of ultrasonic systems

The usage of electrical analogies for the simulation of wave generation and propagation in ultrasound transducers is well established. In this paper a PSpice approach that includes the temperature and frequency dependency of the transducer performance is proposed. The analogy between acoustic wave propagation and wave propagation in an electric transmission line is given. Further ways to deduce temperature and frequency dependencies are discussed. The simulation approach is applied to a pulse-echo setup for the determination of speed of sound and attenuation in liquids and solids. Experiments and simulations are made for three temperatures and in the frequency range 1-12 MHz using water, glycerine, and polymers (PMMA and PEEK) as test samples. Comparison shows a good agreement between simulation and experiments. Results for glycerine indicates that the available attenuation models for high viscosity liquids is inappropriate.