Lay summary
Gout is particularly prevalent in Aotearoa/New Zealand, with 13.8% of Māori men, 22.5% of Pacific men, and 6.9% of New Zealand European men affected. Effective management requires lowering the blood urate level to a treatment target, usually with a medication called allopurinol. There are important inequities based on ethnicity in allopurinol prescribing in Aotearoa. The current best practice treatment strategy is time consuming and difficult to implement. An easier way to use allopurinol is required, especially since gout disproportionately affects middle-age men who are frequently working and are not able to take time off work or afford the costs involved with the current strategy. The aim of this programme is to determine whether a protocol-driven allopurinol dose escalation strategy based on the dose predicted to achieve target urate is as effective as the current best practice intensive treat-to-target strategy.