Febuxostat Compared with Allopurinol in Patients with Hyperuricemia and Gout

Becker, Michael A.; Schumacher, H. Ralph; Wortmann, Robert L.; MacDonald, Penny A.; Eustace, Denise; Palo, William; Streit, Janet; Joseph‐Ridge, Nancy

doi:10.1056/nejmoa050373

Cited by 1,132 publications

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References 31 publications

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“…The relatively high dropout rate was mainly due to the design of the study (cohort) in combination with the sudden need for alternative treatment. On the other hand, we found a mean relative decrease in sUr of 61% for benzbromarone and 36% for allopurinol, which corresponds well with values published in the literature of 54-58% for benzbromarone 80-125 mg/day and 27-44% for allopurinol 300 mg/day in patients not previously treated with benzbromarone [5,15,16,23,24].…”

Section: Discussionsupporting

confidence: 88%

“…Reported events were rash, pruritus, diarrhoea, nausea and dizziness, which are all well-known side effects of allopurinol. Becker et al [23] found a similar rate (12%) of adverse events related to allopurinol.…”

Section: Discussionmentioning

confidence: 76%

“…The uricostatic febuxostat may be available soon. Recently, it was shown that when using febuxostat 80-120 mg/day, 47-66% of the patients reached sUr levels ≤0.30 mmol/l compared to 13% with allopurinol 300 mg/day [23]. A new promising treatment option for patients with severe tophaceous gout is the development of recombinant uricase [29,30] and pegylated recombinant uricase.…”

Section: Discussionmentioning

confidence: 99%

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Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

et al. 2007

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

et al. 2007

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“…The proportion of patients with gout flares requiring treatment declined over 52 weeks, similar to that observed in other studies with febuxostat or allopurinol 5, 6, 8. Longer‐term treatment may be needed to further reduce gout flares, as well as to dissolve baseline tophi, particularly to demonstrate treatment effect differences 24, 25.…”

Section: Discussionsupporting

confidence: 75%

Lesinurad, a Selective Uric Acid Reabsorption Inhibitor, in Combination With Febuxostat in Patients With Tophaceous Gout: Findings of a Phase III Clinical Trial

Dalbeth

Jones

Terkeltaub

et al. 2017

Arthritis & Rheumatology

131

137

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ObjectiveTo investigate the efficacy and safety of lesinurad in combination with febuxostat in a 12‐month phase III trial in patients with tophaceous gout.MethodsPatients with serum urate (UA) ≥8.0 mg/dl (≥6.0 mg/dl with urate‐lowering therapy) and ≥1 measurable target tophus were given febuxostat 80 mg/day for 3 weeks before randomization to receive lesinurad (200 or 400 mg daily) or placebo in addition to the febuxostat. The primary end point was the proportion of patients achieving a serum UA level of <5.0 mg/dl (month 6). The key secondary end point was the proportion of patients with complete resolution of ≥1 target tophus (month 12). Other end points included the percentage change in total target tophi area. Safety assessments included adverse events and laboratory data.ResultsPatients (n = 324) were predominantly male, with a mean age of 54.1 years. Significantly more patients achieved the serum UA target by month 6 with the addition of lesinurad 400 mg (76.1%; P < 0.0001), but not 200 mg (56.6%; P = 0.13), to the febuxostat therapy as compared with febuxostat alone (46.8%). At all other time points, significantly more patients in the lesinurad 200 mg group achieved the serum UA target. The number of patients with complete tophus resolution was not different between groups. Treatment with lesinurad (200 mg and 400 mg) plus febuxostat reduced the total target tophi area as compared with febuxostat alone (50.1% and 52.9% versus 28.3%, respectively; P < 0.05). Safety was generally comparable with that of febuxostat alone, except for higher rates of predominantly reversible elevations in the serum creatinine level, particularly with lesinurad 400 mg.ConclusionTreatment with lesinurad in combination with febuxostat demonstrated superior lowering of serum UA levels as compared with febuxostat alone, with clinically relevant added effects on tophi and an acceptable safety profile with lesinurad 200 mg in patients with tophaceous gout warranting additional therapy.

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“…A treat-to-target serum urate (SU) strategy for gout patients with an indication for urate-lowering therapy (ULT) has been widely endorsed as a means of optimizing clinical outcomes. Achievement of an SU ,6.0 mg/dl has been associated with improved outcomes, including reductions in gout flare frequency and tophi (2)(3)(4)(5)(6)(7). Thus, multiple international guidelines support the adoption of such a treatment target (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Target Serum Urate: Do Gout Patients Know Their Goal?

Coburn

Bendlin

Sayles

et al. 2016

Arthritis Care & Research

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Objective. To examine gout patients' knowledge of their condition, including the central role of achieving and maintaining the serum urate (SU) goal with the use of urate-lowering therapy (ULT).Methods. This study of 612 gout patients was conducted at a Veterans Affairs medical center. Gout patients were included based on administrative diagnostic codes and receipt of at least 1 allopurinol prescription over a 1-year period. Questionnaires were mailed to patients and linked to medical records data. The questionnaire included goutspecific knowledge questions, the Patient Activation Measure, and self-reported health outcomes. Knowledge was assessed descriptively. Multivariable logistic regression was used to determine predictors of SU goal knowledge. Associations of knowledge with health outcomes were examined in exploratory analyses. Results. The questionnaire had a 62% response rate. Only 14% of patients knew their SU goal, while the majority answered correctly for the other 5 gout-specific knowledge questions. In adjusted analyses, having a rheumatologist as initial prescriber (odds ratio [OR] 3.0 [95% confidence interval (95% CI) 1.4-6.2]) and knowing all of the other 5 gout-specific knowledge questions (OR 2.1 [95% CI 1.3-3.4]) were associated with greater odds of knowing the SU goal. SU goal knowledge was associated with self-reported global health status, but not with self-reported health-related quality of life or gout-specific health status. Conclusion. There is a knowledge deficit regarding the SU treatment goal among gout patients receiving ULT, despite generally high levels of other gout-specific knowledge. SU goal information may be an important and underutilized concept among providers treating gout patients.

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Febuxostat Compared with Allopurinol in Patients with Hyperuricemia and Gout

Abstract: Febuxostat, at a daily dose of 80 mg or 120 mg, was more effective than allopurinol at the commonly used fixed daily dose of 300 mg in lowering serum urate. Similar reductions in gout flares and tophus area occurred in all treatment groups.

Cited by 1,132 publications

References 31 publications

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

Lesinurad, a Selective Uric Acid Reabsorption Inhibitor, in Combination With Febuxostat in Patients With Tophaceous Gout: Findings of a Phase III Clinical Trial

Target Serum Urate: Do Gout Patients Know Their Goal?

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