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Trial registered on ANZCTR
Registration number
ACTRN12611000743965
Ethics application status
Approved
Date submitted
13/07/2011
Date registered
15/07/2011
Date last updated
26/09/2016
Type of registration
Retrospectively registered
Titles & IDs
Public title
Optimising allopurinol therapy in the treatment of gout.
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Scientific title
Understanding the dose-response relationship of allopurinol in patients with gout.
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Secondary ID [1]
262615
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Nil
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Universal Trial Number (UTN)
U1111-1122-8998
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Gout
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Condition category
Condition code
Inflammatory and Immune System
268440
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0
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Other inflammatory or immune system disorders
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Musculoskeletal
268464
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0
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Other muscular and skeletal disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Patients who have gout and not yet taking allopurinol will be recruited. They will then start with a low dose of allopurinol taken by oral tablet. This low dose will be 50 mg/day (for low renal function) or 100 mg/day (for normal renal function). Patients will take allopurinol for at least 1-2 weeks, being sufficient time to reach steady state concentrations (depending on renal function). Patients will then have the following measured: plasma and urinary urate and creatinine concentrations using standard biochemical analyses and plasma oxypurinol concentrations using a validated method. Based on the efficacy of the dose of allopurinol in lowering plasma urate concentrations and at the discretion of the consultant rheumatologist, the rate of the dose increase and the size of the dose increase will rise. Two weeks after each dose increase, the above mentioned analytes will again be measured. This intervention will continue until the plasma urate concentrations drop to 0.30 mg/L.
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Intervention code [1]
266962
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Treatment: Drugs
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Comparator / control treatment
Participants with similar renal functions will start with the same dose regime (50 mg/day for low renal function and 100 mg/day for normal renal function). Dose increases and the rate of increase will be dependent on the efficacy of particular doses in lowering plasma urate concentrations.
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Control group
Active
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Outcomes
Primary outcome [1]
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To understand the dose-response relationship of allopurinol.
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Assessment method [1]
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Timepoint [1]
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Plasma urate, creatinine and oxypurinol concentrations will be monitored after each dose escalation until the close of the study.
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Primary outcome [2]
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To achieve plasma urate concentrations lower than 0.30 mmol/L in patients with gout.
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Assessment method [2]
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Timepoint [2]
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Allopurinol will be titrated upwards in patients with gout until plasma urate concentrations are lower than 0.30 mmol/L.
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Secondary outcome [1]
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Determine what factors (dose, oxypurinol concentration, creatinine clearance, baseline plasma urate concentration) affect plasma urate concentrations achieved during treatment of allopurinol.
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Assessment method [1]
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Timepoint [1]
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Factors that affect plasma urate concentrations of urate during allopurinol treatment will be determined after patients have reached plasma urate concentrations lower than 0.30 mmol/L.
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Eligibility
Key inclusion criteria
Suffer from clinically diagnosed gout and commencing allopurinol therapy
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Poor venous access for venepuncture.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Other
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Other design features
Participants start to receive different doses of the intervention based on their renal function. The rate at which the dose is increased and the size of the dose increase is based on their response to the treatment. This response is measured by plasma urate concentrations.
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Phase
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
12/06/2008
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Actual
13/11/2008
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Date of last participant enrolment
Anticipated
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Actual
20/07/2010
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Date of last data collection
Anticipated
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Actual
9/08/2010
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Sample size
Target
30
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Accrual to date
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Final
37
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Recruitment in Australia
Recruitment state(s)
NSW
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Research Council Safety Grant
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Address [1]
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National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
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Country [1]
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Australia
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Funding source category [2]
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Charities/Societies/Foundations
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Name [2]
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Lexy Davies Bequest
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Address [2]
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Department of Clinical Pharmacology & Toxicology
Level 2 Xavier Building,
St Vincent's Hospital, Victoria St
Darlinghurst NSW 2010
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Country [2]
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Australia
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Primary sponsor type
Individual
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Name
Richard Day
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Address
Department of Clinical Pharmacology & Toxicology
Level 2 Xavier Building,
St Vincent's Hospital, Victoria St
Darlinghurst NSW 2010
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
266477
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
269404
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St Vincent's Hospital Human Research Ethics Committee
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Ethics committee address [1]
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Research Office Level 6 deLacy Building, St Vincent's Hospital, Victoria St Darlinghurst NSW 2010
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Ethics committee country [1]
269404
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Australia
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Date submitted for ethics approval [1]
269404
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Approval date [1]
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31/10/2006
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Ethics approval number [1]
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H06/107, 08/172
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Summary
Brief summary
Gout is the most common inflammatory disease in the western hemisphere where its incidence seems to be rising. Allopurinol is a widely used and effective treatment for gout. It is used to lower plasma urate concentrations in the body, which in-turn prevents acute gout attacks. It's use, however, has been shown to be sub-optimal. Patients are not reaching target plasma urate concentrations recommended by treatment guidelines due to low dosing of allopurinol. Thus this project aims to understand the dose-response relationship of allopurinol and optimise the dose for patients, such that patients reach target plasma urate concentrations.
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Trial website
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Trial related presentations / publications
Stocker SS et al. (2012). The pharmacokinetics of oxypurinol in people with gout. Br J Clin Pharmacol 74 (3): 477-489. Kannangra DRW et al. (2012). Fractional clearance of urate: validation of measurement in spot-urine samples in healthy subjects and gouty patients. Arth Res Ther 14: R189 Graham GG et al. (2013). Understanding the dose-response relationship of allopurinol: predicting the optimal dose. Br J Clin Pharmacol 76: 932-8.
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Public notes
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Contacts
Principal investigator
Name
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Prof Richard Day
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Address
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Department of Clinical Pharmacology & Toxicology Level 2 Xavier Building, St Vincent's Hospital, 390 Victoria St Darlinghurst NSW 2010
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Country
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Australia
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Phone
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+61 2 8382 2304
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Richard Day
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Address
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Department of Clinical Pharmacology & Toxicology
Level 2 Xavier Building,
St Vincent's Hospital, Victoria St
Darlinghurst NSW 2010
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Country
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Australia
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Phone
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+61 2 8382 2304
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Fax
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+61 2 8382 2724
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Email
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[email protected]
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Contact person for scientific queries
Name
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Richard Day
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Address
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Department of Clinical Pharmacology & Toxicology
Level 2 Xavier Building,
St Vincent's Hospital, Victoria St
Darlinghurst NSW 2010
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Country
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Australia
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Phone
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+61 2 8382 2304
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Fax
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+61 2 8382 2724
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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