P5949 - Allopurinol Therapy in Cirrhotic Patients: Impact on Uric Acid and Liver Enzymes

Mohammed Abu-Rumaileh, MD¹, Sana Rabeeah, MD¹, Mhd Kutaiba Albuni, MD², Yusuf Omar Hallak, MD¹, Maram Albandak, MD¹, Bisher Sawaf, MD³, Fayaz Khan, MD⁴, Manthan Bhai Patel, MD¹, Sami Ghazaleh, MD⁵
1The University of Toledo, Toledo, OH; 2Department of Internal Medicine, TriHealth Inc., Cincinnati, Cincinnati, OH; 3University of Toledo Medical Center, Toledo, OH; 4TriHealth, Cincinnati, OH; 5University of Toledo, Toledo, OH

Introduction: Hyperuricemia is frequently observed in cirrhosis and is associated with oxidative stress, inflammation, and endothelial dysfunction, potentially contributing to disease progression. Allopurinol, a xanthine oxidase inhibitor, may mitigate these mechanisms. This study aimed to evaluate the association between allopurinol use and changes in clinical and biochemical markers among individuals with cirrhosis using a large population-based cohort.

Methods: Using the TriNetX research network, we identified adults with confirmed cirrhosis. Allopurinol exposure was defined as use during ≥ five clinical encounters after cirrhosis diagnosis. Patients were matched 1:1 using propensity scores based on demographics, comorbidities, cirrhosis etiology, medication use, and baseline labs. The primary outcomes included changes in uric acid, liver function tests (ALT, AST, albumin, total bilirubin), and renal function (creatinine) over a mean follow-up of 135 days. Triglycerides were also assessed as a metabolic marker.

Results: After matching, 5358 patients were included in each group. Allopurinol use was associated with greater reductions in serum uric acid (−2.1 mg/dL vs −0.4 mg/dL, p < 0.01), ALT (−14.2 U/L vs −6.5 U/L), and AST (−12.3 U/L vs −4.8 U/L) compared to controls. Albumin levels increased and total bilirubin decreased in the allopurinol group, though these changes were not statistically significant. No significant changes in serum creatinine were observed, suggesting no adverse renal impact.

Discussion: In this large, matched cohort of cirrhotic patients, allopurinol use was associated with significant improvements in uric acid levels and favorable trends in liver enzymes. These findings support a potential biochemical benefit of allopurinol in cirrhosis and warrant prospective investigation into its clinical implications.

Disclosures:
Mohammed Abu-Rumaileh indicated no relevant financial relationships.
Sana Rabeeah indicated no relevant financial relationships.
Mhd Kutaiba Albuni indicated no relevant financial relationships.
Yusuf Omar Hallak indicated no relevant financial relationships.
Maram Albandak indicated no relevant financial relationships.
Bisher Sawaf indicated no relevant financial relationships.
Fayaz Khan indicated no relevant financial relationships.
Manthan Bhai Patel indicated no relevant financial relationships.
Sami Ghazaleh indicated no relevant financial relationships.

Mohammed Abu-Rumaileh, MD¹, Sana Rabeeah, MD¹, Mhd Kutaiba Albuni, MD², Yusuf Omar Hallak, MD¹, Maram Albandak, MD¹, Bisher Sawaf, MD³, Fayaz Khan, MD⁴, Manthan Bhai Patel, MD¹, Sami Ghazaleh, MD⁵. P5949 - Allopurinol Therapy in Cirrhotic Patients: Impact on Uric Acid and Liver Enzymes, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.