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 patients with
renal insufficiency.
Febuxostat, an orally administered, nonpurine inhibitor of
xanthine oxidase, was recently approved by the U.S. Food and Drug administration for chronic management of
hyperuricemia in patients with
gout. Patients treated with
febuxostat achieve rapid and substantial reductions in sUA levels. Compared with
allopurinol-treated patients, patients receiving
febuxostat 80 mg/day were more likely to achieve sUA concentrations less than 6 mg/dl. In long-term studies (up to 5 yrs),
febuxostat demonstrated sustained reductions in sUA levels, nearly complete elimination of
gout flares, and a frequency of adverse effects comparable to
allopurinol. The most commonly reported adverse effects were liver function abnormalities,
rash,
nausea, and
arthralgias. The recommended starting dose of
febuxostat is 40 mg/day, which may be increased to 80 mg/day after 2 weeks if patients do not achieve sUA levels less than 6 mg/dl. Dosage adjustment in mild-to-moderate
renal insufficiency is unnecessary; however, data are lacking on the safety of
febuxostat in patients with severe renal impairment. Although more costly than
allopurinol,
febuxostat appears to be an acceptable alternative for the treatment of
gout and
hyperuricemia, and may be advantageous in patients with renal impairment, intolerance to
allopurinol, or the inability to attain sUA levels less than 6 mg/dl despite adequate
therapy with available agents.