In the ASPirin in Reducing Events in the Elderly (ASPREE) trial, older adults with gout taking allopurinol had a reduced risk of persistent physical disability, but their risk of frailty was unchanged. “Future randomized trials and high-quality population-based observational studies are needed to determine whether allopurinol can prevent physical disability,” the investigators conclude.
At baseline, 19,114 participants were 65 years of age or more and without prior cardiovascular events, dementia, or independence-limiting physical disability. Baseline and time-varying allopurinol use was examined in participants with self-reported gout or use of antigout medications. Patterns of persistent physical disability and new-onset frailty were as follows: “This analysis included 1,155 gout participants, with 630 taking allopurinol at baseline and 525 not. During a median follow-up of 5.7 years, 113 new allopurinol users were identified. Compared with nonusers, baseline allopurinol use was associated with a significant risk reduction of persistent physical disability (Adjusted HR 0.46, 95% CI 0.23–0.92, P = 0.03). The strength of the association was modestly attenuated in the time-varying analysis (Adjusted HR 0.56, 0.29–1.08, P = 0.08). No significant associations with frailty measures were observed for either baseline allopurinol use (Fried frailty: Adjusted HR 0.83, 0.62–1.12; FI: Adjusted HR 0.96, 0.74–1.24) or time-varying allopurinol use (Fried frailty: Adjusted HR 0.92, 0.69–1.24; FI: Adjusted HR 1.02, 0.78–1.33).”