Urate‐Lowering Therapy for Gout: Focus on Febuxostat

  title={Urate‐Lowering Therapy for Gout: Focus on Febuxostat},
  author={Bryan L. Love and Robert Barrons and Angie Veverka and K Snider},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
  • B. Love, R. Barrons, K. Snider
  • Published 1 June 2010
  • Medicine
  • Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Gout is a common, painful, and often debilitating rheumatologic disorder that remains one of the few arthritic conditions that can be diagnosed with certainty and cured with appropriate therapy. Allopurinol is the most frequently prescribed agent for gout in the United States. Unfortunately, most patients treated with allopurinol do not achieve target serum uric acid (sUA) levels, possibly due to a perceived intolerability to allopurinol in doses above 300 mg and the need for reduced doses in… 
Febuxostat for the treatment of hyperuricemia in patients with gout
Febuxostat may be a safe and effective alternative for treating gout patients where allopurinol 300 mg/day is neither safe nor effective.
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Low-dose febuxostat is a promising alternative to allopurinol for the treatment of gouty arthritis or tophi in peritoneal dialysis patients and considered to be an alternative treatment for hyperuricemic patients with chronic kidney disease.
Pharmacokinetics considerations for gout treatments
Canakinumab appears to be a good alternative for patients with contraindications to colchicine, NSAIDs and corticosteroids, and co-prescription with strong CYP3A4 or P-glycoprotein inhibitors can greatly modify its pharmacokinetics is to be avoided.
An open-label, 6-month study of allopurinol safety in gout: The LASSO study.
Febuxostat as a Novel Option to Optimize Thiopurines’ Metabolism in Patients With Inadequate Metabolite Levels
It has been shown that low dose of febuxostat was able to prevent hypermethylation and to potentiate 6-TGN levels in an AZA-treated patient, and could be useful in optimizing thiopurines’ metabolism.
Comparison of persistence rates between allopurinol and febuxostat as first-line urate-lowering therapy in patients with gout: an 8-year retrospective cohort study
Long-term persistence of XOIs was suboptimal, and allopurinol had worse persistence rates than febuxostat among patients with gout, suggesting that febUXostat is a better option for long-term ULT in light of medication adherence in a real-world setting.
Hyperuricaemia: more than just a cause of gout?
This narrative review considers the significant associations of SUA with kidney function, several CV risk factors and vascular diseases, supporting the concept of assessing hyperuricaemia for reasons other than just gout.
Rhabdomyolysis associated with initiation of febuxostat therapy for hyperuricaemia in a patient with chronic kidney disease
A case of rhabdomyolysis associated with initiation of febuxostat in a patient with chronic kidney disease (CKD) is reported.
Intractable Epistaxis with Febuxostat
Clinicians may consider alternate gout therapy in patients at high risk or taking medications that increase their risk for bleeding after an 86-year-old female presented to the ED after onset of intractable epistaxis following initiation of febuxostat.


Emerging therapies in the long‐term management of hyperuricaemia and gout
Febuxostat, a new xanthine oxidase inhibitor, is an effective hypouricaemic agent although further data are required for patients with renal impairment and other significant medical conditions.
Management of Acute and Chronic Gouty Arthritis
The use of recombinant urate oxidase in patients with chronic gout is limited by the need for parenteral administration, the potential antigenicity and production of anti-urate oxidase antibodies, and declining efficacy.
Therapeutic advances in gout
Proper gout management requires changes to the physician's attitude towards the disease; essentially: an unequivocal diagnosis based in urate crystal identification, a clearly settled aim of the treatment: crystal elimination from the joints and elsewhere, and proper use of the available therapeutic alternatives.
Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial.
At all doses studied, febuxostat more effectively lowered and maintained serum urate levels <6.0 mg/dl than did allopurinol (300 or 100 mg) or placebo in subjects with hyperuricemia and gout, including those with mild to moderately impaired renal function.
Azathioprine and Allopurinol: The Price of an Avoidable Drug Interaction
Undetected drug interactions can be life-threatening to patients as well as costly to the healthcare system and drug interactions also can have a profound negative effect on the patients' quality of life.
Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: a twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout.
Treatment with febuxostat resulted in a significant reduction of sUA levels at all dosages and was safe and well tolerated.
A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis.
Allopurinol in its generic formulation was the ULD that presented the lowest incremental cost effectiveness ratio and is cost effective if patients present 2 or more recurrent attacks/year.
Allopurinol hypersensitivity syndrome: a preventable severe cutaneous adverse reaction?
Allopurinol hypersensitivity syndrome is a life-threatening cutaneous adverse reaction that should be initiated under clear indications with appropriate dosages, and potential associations with this syndrome include the Chinese race, the elderly, and patients with underlying renal impairment.
Systemic corticosteroids for acute gout.
There is inconclusive evidence for the efficacy and effectiveness of systemic corticosteroids in the treatment of acute gout, but patients with gout did not report serious adverse effects from systemic cortICosteroids, when used short term.