Febuxostat in the treatment of gout patients with low serum uric acid level: 1-year finding of efficacy and safety study

Abstract

To retrospectively analyze the efficacy and safety of febuxostat on gout patients with low serum uric acid level. A study was conducted in Nanjing First Hospital from October 2015 to September 2016. Thirty nine acute gouty arthritis patients from the emergency and outpatient department were included. Patients met the 2015 Gout Classification Criteria revised by American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and had urate deposition around the joints detected by dual-energy computerized tomography (DECT). Patients whose serum uric acid (SUA) were between 5.0 and 7.0 mg/dl (300-420 μmol/l) received febuxostat treatment to maintain the SUA level between 3.0 and 5.0 mg/dl for 1 year. Efficacy and safety of febuxostat were observed during the process. Three of 39 subjects were excluded because of adverse events (AEs) after receiving an initial febuxostat treatment for 2 months. Thirty six subjects were enrolled. The mean SUA level was reduced significantly from 6.51 ± 0.28 mg/dl at baseline to 4.24 ± 0.38 mg/dl and SUA of all subjects decreased by 34.8% compared with baseline. After 1-year treatment, the volume of tophus was reduced approximately 62.8%. Serum creatinine decreased stepwise in 8 gout patients with chronic kidney diseases from 162.5 ± 9.2 μmol/l to 131.4 ± 11.0 μmol/l. Two months after initiation of treatment, the number of gout flares began to markedly decrease and almost did not occur after 1 year. After the 1-year treatment of febuxostat, the average SUA level declined significantly, and the renal function improved gradually. There was nearly complete abolition of gout flares by the end of the study. Tophi resolved markedly compared with baseline as assessed by DECT. Furthermore, only a few people experienced adverse events. Febuxostat has a notable effect for gout patients in the lower SUA level range.

Studies on the Anti-Gouty Arthritis and Anti-hyperuricemia Properties of Astilbin in Animal Models

“…The clinical agents for gouty arthritis treatment include colchicine (COL), corticosteroids and non-steroidal anti-inflammatory drugs [9,10]. Allopurinol and febuxostat (FB) are the main clinical agents for treatment of hyperuricemia [11,12], but show little effect on gouty arthritis [13]. However, the sideeffects including liver damage, nephrotoxicity and bone marrow inhibition have been observed in clinics [11,12,14].…”

Towards a more ambitious uricemia target to improve joint and cardiovascular outcomes in gout

“…Observational studies also have shown that the lower the SUA, the better the joint clinical outcomes, owing to the faster dissolution of the MSU deposits [23,24]. Likewise, studies using dual-energy computed tomography or ultrasonography to assess the urate crystal burden in joints found a more significant decrease in MSU deposits in gout patients who achieve SUA < 5 mg/dL with appropriate treatment [25,26]. Curiously, in the Sons of Gout Study, Abhishek et al [27] did not find urate deposition in asymptomatic patients with SUA ≤ 5 mg/dL and a family history of gout, whereas ultrasound revealed MSU deposits in 24.2% of those with SUA between 5 mg/dL and 6 mg/dL.…”