Table 4.

Recommendations for patients taking specific urate-lowering therapy (ULT) medications^*

Recommendation	PICO question	Certainty of evidence
Allopurinol
We conditionally recommend testing HLA–B*5801 prior to starting allopurinol for patients of Southeast Asian descent (e.g., Han Chinese, Korean, Thai) and African American patients, who have a higher prevalence of HLA–B*5801.	12	Very low
We conditionally recommend against HLA–B*5801 testing in all others.
For patients with a prior allergic response to allopurinol who cannot be treated with other oral ULT, we conditionally recommend using allopurinol desensitization.	23	Very low
Febuxostat
For patients with gout taking febuxostat with a history of CVD or a new CV event, we conditionally recommend switching to an alternative ULT agent if available and consistent with other recommendations in this guideline.	22	Moderate
Uricosurics
For patients considered for, or taking uricosuric treatment, prior to starting any uricosuric treatment, we conditionally recommend against checking urinary uric acid over checking urinary uric acid.	28	Very low
For patients taking uricosuric treatment, we conditionally recommend against alkalinizing urine.	29	Very low
Strongly recommend Conditionally recommend Strongly recommend against Conditionally recommend against

^*PICO = population, intervention, comparator, outcomes; CVD = cardiovascular disease.