Elevated Liver Enzymes Is Not an Impediment to Allopurinol Dose Escalation: An Observational Cohort Study
Authors' conclusion
Mild asymptomatic AST/ALT elevation is common among patients with gout and is not influenced by allopurinol dose escalation. Alcohol consumption was an independent risk factor for elevated liver enzyme levels, whereas statin use appeared protective.
Study context
- Population
- Patients with gout and normal baseline serum aminotransferases initiated on allopurinol (mean age 56.6 years; 95.3% men)followed over three visits
- Participants
- 150 patients
- Outcome
- Incidence of raised AST/ALT levels (mild <2, moderate 2–3, severe >3 times upper normal limits)
Methodological detailsobservational, generalized estimating equations
- Observational
- Generalized estimating equations
Main finding
As reported in the abstract
Raised AST/ALT levels during follow-up · median follow-up 33.5 weeks (IQR 22.8-53.1)
Raised AST/ALT levels
30
20.0%
Mild among raised
86.7%
Severe
0
Observational data: associations, not effects.
Further findings
Independent predictors of raised transaminase levels (multivariate analysis)
| aOR (95% CI) | ||
|---|---|---|
| Alcohol consumption | 3.52 (1.41–8.79) | |
| Statin nonuse | 3.41 (1.04–11.17) | |
| 0.050.21520Adjusted odds ratio (log scale) |
- Independent predictors of raised transaminase levels (multivariate analysis) — Higher allopurinol dose not associated with liver enzyme elevation
- P = 0.193
Course of raised AST/ALT at visit 2 (allopurinol maintained or increased in 18 of 19) · subsequent visit
- Stable
- 27.8%
- Improved
- 11.1%
- Resolved
- 33.3%
- Worsened
- 0
Original publication
Elevated Liver Enzymes Is Not an Impediment to Allopurinol Dose Escalation: An Observational Cohort Study. Arthritis Care Res (Hoboken). Published 7 September 2026. doi:10.
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