Effect of febuxostat on renal function in patients from South China with CKD3 diabetic nephropathy / Efeito do febuxostat na função renal em pacientes do sul da China com nefropatia diabética com DRC3

ABSTRACT Objective: To investigate the efficacy and safety of febuxostat on renal function in CKD stage 3 diabetic nephropathy patients. Methods: Patients in our hospital with chronic kidney disease (CKD) stage 3 diabetic nephropathy (DN) complicated by high serum uric acid (360 µmol/L) were recruited. Patients were then divided into treatment group and control group according to the random number table method. All the patients received low purine diet, renin-angiotensin-aldosterone system (RAAS) inhibitors, and adequate routine hypoglycemic treatment. Febuxostat was employed only in the treatment group. The levels of blood uric acid (sUA), serum creatinine (Scr), cystatin C (cys-c), eGFR, 24-hour urine protein quantification, albuminuria, and creatinine ratio (ACR) were evaluated in all patients before and after treatment at 4, 8, 12, and 24 week. Results: No difference was found before treatment between the two groups. After treatment at 4, 8, 12, and 24 week, the levels of sUA, SCr, cys-c, and eGFR between the two groups were significant different (P<0.05). There was no difference in 24-hour urine protein quantification, albuminuria, and creatinine ratio between two groups before treatment, and significant differences were observed after treatment. Fifty percent of patients from the treatment group achieved the treatment goal with 20 mg febuxostat at 4 weeks. Tubular markers were also decreased with the treatment. Conclusions: Febuxostat can reduce uric acid and improve renal function effectively in patients with CKD stage 3 diabetic nephropathy, while being well tolerated. However, the conclusion is still uncertain due to the short term of the study.

RESUMO Objetivo: Investigar a eficácia e segurança do febuxostat na função renal em pacientes com DRC estágio 3, com nefropatia diabética. Métodos: Foram recrutados pacientes em nosso hospital com nefropatia diabética (DN) estágio 3 de doença renal crônica (DRC) complicada por ácido úrico sérico alto (360 µmol/L). Os pacientes foram então divididos em grupo de tratamento e grupo controle, de acordo com o método da tabela de números aleatórios. Todos os pacientes receberam dieta pobre em purinas, inibidores do sistema renina-angiotensina-aldosterona (RAAS) e tratamento hipoglicêmico de rotina. O Febuxostat foi empregado apenas no grupo de tratamento. Os níveis de ácido úrico no sangue (AIU), creatinina sérica (Scr), cistatina C (cys-c), TFGe, quantificação de proteínas na urina em 24 horas, razão albumina e creatinina (ACR) foram avaliados em todos os pacientes antes e após o tratamento às 4, 8, 12 e 24 semanas. Resultados: Nenhuma diferença foi encontrada antes do tratamento entre os dois grupos. Após o tratamento nas 4, 8, 12 e 24 semanas, os níveis de sUA, SCr, cys-c e TFGe entre os dois grupos foram significativamente diferentes (P <0,05). Não houve diferença na quantificação de proteínas na urina em 24 horas, albuminúria e razão de creatinina entre dois grupos antes do tratamento, e diferenças significativas foram observadas após o tratamento. Cinquenta por cento dos pacientes do grupo de tratamento atingiram a meta de tratamento com 20 mg de febuxostat em 4 semanas. Marcadores tubulares também foram reduzidos com o tratamento. Conclusões: O Febuxostat pode reduzir o ácido úrico e melhorar a função renal efetivamente em pacientes com nefropatia diabética estágio com DRC no estágio 3, sendo bem tolerado. No entanto, a conclusão ainda é incerta devido ao curto prazo do estudo.

Informe diário de evidências COVID-19: busca realizada em 1 de julho de 2020 / COVID-19 daily evidence report: search conducted on July 1, 2020

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 14 artigos e 6 protocolos.

Efficacy of Febuxostat for the prevention of Tumor Lysis Syndrome in patients with Hematological and Soft Tissue Malignancies: A meta-analysis

Introduction@#Tumor lysis syndrome (TLS) is a therapy-related complication resulting from the rapid lysis of malignant cells post-treatment. The control of serum uric acid level plays a key role in its prevention, thus, allopurinol is used. Febuxostat is a novel xanthine oxidase inhibitor and there are currently no recommendations for using such in the prevention of TLS, hence, this study was conducted. This study aims to determine the efficacy of febuxostat in the prevention of TLS. @*Methods@#Extensive search for randomized controlled trials (RCT) focusing on the use of febuxostat in the prevention of TLS was done. Each article was appraised independently by the researchers. The data were analysed using Rev Man 5.3.@*Results@#Two trials were included in this review. The study results revealed that febuxostat, when compared to allopurinol, was able to decrease serum uric acid as hyperuricemia is the hallmark of TLS. This decrease in serum uric acid was consistent in both studies. Serum uric acid levels at the end of the treatment showed a standard mean difference of -1.09 (95% CI-1.29, -0.88, p for heterogeneity <0.01, p for effect <0.01, I2 = 97%). The trend of both studies favored the efficacy of febuxostat. The adverse effects documented during the study period in both trials were mostly noted from the chemotherapeutic agents and none from the use of febuxostat.@*Conclusion@#Febuxostat was shown to be more effective than allopurinol in the prevention of TLS.

Comparison of Efficacy and Safety of Febuxostat in Gout Patients with Chronic Kidney Disease Stage 3 and Stage 4/5

OBJECTIVE: To compare efficacy and safety of febuxostat in gouty patients with chronic kidney disease (CKD) stage 3 and stage 4/5. METHODS: Age and sex matched patients with CKD stage 3 and stage 4/5 who were diagnosed with gout were included. The dose of febuxostat was increased according to serum uric acid (sUA) level. Adherence, the number of gout attack, the change of sUA, the change of estimated glomerular filtration rate (eGFR) and adverse events (AEs) were evaluated for 12 months. RESULTS: There were no significant differences in the baseline variables between CKD stage 3 and CKD stage 4/5. Disease duration was longer and baseline sUA was higher in the CKD stage 4/5. There were no significant differences in the mean sUA at the last follow-up, the number of patients who reached the sUA target of 6 mg/dL and the number of gout attack between the groups. There were no significant differences in the change of eGFR and decrease of eGFR between the groups. There were 2 cases of AEs. One patient in CKD stage 3 had maculopapular rash and one patient in CKD stage 4/5 had dizziness. The AEs were subsided after febuxostat was stopped. CONCLUSION: Febuxostat was efficacious and well tolerated in gout patients with CKD stage 4/5.

Giant Tophi Involving Both Suprapatellar Pouches and Upper Poles of the Patellae: Treatment with Febuxostat and the 6 Years Follow-Up / 대한정형외과학회잡지

Tophi is one of the clinical manifestations of gout. On the other hand, it does not draw the patient's attention when it is asymptomatic, which leads to delayed management. The current case is a typical example of delayed diagnosis and management. The authors' preferred management of tophi was medical not surgical, even though the hitherto therapeutic issue has been conservative versus surgical. The authors chose conservative treatment in the osteolytic lesion resulting from huge tophi in the patella, and the report the results of 6 years follow-up.

Physicians' perceptions of asymptomatic hyperuricemia in patients with chronic kidney disease: A questionnaire survey

BACKGROUND: Hyperuricemia is associated with the development and progression of chronic kidney disease (CKD) as well as cardiovascular diseases. However, there is no consistent recommendation regarding the treatment of asymptomatic hyperuricemia (AHU) in CKD patients. Here, we surveyed Korean physicians’ perceptions regarding the diagnosis and management of AHU in CKD patients. METHODS: Questionnaires on the management of AHU in CKD patients were emailed to regular members registered with the Korean Society of Nephrology. RESULTS: A total of 158 members answered the questionnaire. Among the respondents, 49.4%/41.1% were considered hyperuricemic in male CKD patients whereas 36.7%/20.9% were considered hyperuricemic in female CKD patients when defined by serum uric acid level over 7.0/8.0 mg/dL, respectively. A total of 80.4% reported treating AHU in CKD patients. The most important reasons to treat AHU in CKD patients were renal function preservation followed by cerebro-cardiac protection. Majority of respondents (59.5%) thought that uric acid-lowering agents (ULAs) were the most effective method for controlling serum uric acid levels. Approximately 80% chose febuxostat as the preferred medication. A total of 32.3% and 31.0%, respectively, initiated ULA treatment if the serum uric acid level was more than 8.0 or 9.0 mg/dL, respectively. In addition, 39.2% and 30.4% answered that target serum uric acid levels of less than 6.0 or 7.0 mg/dL, respectively, were appropriate. The two major hurdles to prescribing ULAs were concerns of adverse reactions and the existing lack of evidence (i.e., the absence of Korean guidelines). CONCLUSION: Most Korean physicians treat AHU in CKD patients to prevent CKD progression and cerebro-cardiovascular complications.

A case of gout secondary to primary myelofibrosis / 北京大学学报(医学版)

A 52-year-old man was referred to our department with a 2-year history of polyarthritis. He was diagnosed as gout due to acute arthritis of bilateral feet dorsum 2 years ago,but he didn't receive any standard treatment. 1 year ago,there were more and more joints evolved during the gout attack, and many subcutaneous nodules occurred. When he presented to our clinic 1 month ago,the urate acid level was as high as 715 μmol/L. Moreover, we could find bone erosion in the X rays of his hand and foot,as well as synovitis,double contour sign and tophus on the ultrasound examination. The diagnosis of gout was clearly and definitely. However, he had leukocytosis and thrombocytosis for 4 years in the past history, and the urate acid level was only 400 μmol/L at that time. He also had well-controlled hypertension. The family history was unremarkable. Furthermore, we found megalosplenia on his physical examination. The bone marrow examination showed myelofibrosis and JAK2 V617F gene was positive. He was diagnosed as primary myelofibrosis and treated with interferon-α, together with urate acid-lowing therapy (febuxostat 60 mg once daily). Following-up for 1 year,the dosage of febuxostat decreased to 40 mg once daily, and the patient didn't have gout attack again, some of the tophus diminished, and the urate acid level ranged from 400 to 500 μmol/L. Gout is a common disease in clinical practice,usually combined with metabolic syndrome,chronic renal failure and specific drugs using (diuretic and calcineurin inhibitors). However,it is relatively rare to see gout associated with myeloproliferative diseases, including polycythemia vera, primary thrombocythemia, primary myelofibrosis and chronic myelocytic leukemia. In these diseases, the turnover of nucleic acids is greatly augmented, and an excess of purine metabolites, including uric acid, is released. In the natural course of gout, the appearance of tophus from the first onset of arthritis usually takes several years. This patient only had one traditional risk factor, but his urate acid level was remarkably high and he developed tophus in a short term. After treatment of primary myelofibrosis, the symptom of gout partially alleviated. Careful physical examination and medical history taking lead to the diagnosis of secondary gout, which should be reminded in the daily practice.

Tratamento da Gota na Atenção Primária à Saúde / Treatment of Gout in the Primary Health Care / Tratamiento de la Gota en la Atención Primaria de la Salud

Objetivo: O objetivo desta revisão é fornecer informação atualizada e orientações práticas sobre a abordagem da gota na Atenção Primária à Saúde. Métodos: Foram pesquisadas normas de orientação clínica, revisões sistemáticas, meta-análises e estudos originais publicados entre 1 janeiro de 2011 e 31 dezembro de 2016, nas línguas inglesa, portuguesa e espanhola. Resultados: Os fármacos de primeira linha no tratamento da gota aguda são os anti-inflamatórios não esteroides, a colchicina e os corticoides, em monoterapia ou associação. Na gota crônica são usados hipouricemiantes, sendo a primeira linha o alopurinol. O febuxostate e os uricosúricos são alternativas ao alopurinol em casos de intolerância ou ineficácia. A profilaxia das crises de gota agudas está recomendada quando se inicia o tratamento hipouricemiante durante pelo menos 6 meses. Conclusão: A abordagem correta da gota deve fazer parte das competências de um médico especialista em Atenção Primária à Saúde de modo a prestar cuidados adequados à comunidade.

Objective: The objective of this review is to provide updated information and practical guidelines on the approach of gout in Primary Health Care. Methods: We conducted a survey of clinical guidelines, systematic reviews, meta-analyses and original studies published between January 1, 2011 and December 31, 2016 in the English, Portuguese and Spanish languages. Results: First-line drugs in the treatment of acute gout are non-steroidal anti-inflammatory drugs, colchicine and corticosteroids, in monotherapy or combination. In chronic gout, the first-line of hypouricemic therapy is allopurinol. Febuxostat and uricosurics are alternatives to allopurinol in cases of intolerance or ineffectiveness. The prophylaxis of acute attacks is recommended when starting hypouricemic treatment for at least 6 months. Treatment of asymptomatic hyperuricemia is not recommended. Conclusion: The correct approach to gout should be part of the skills of a Primary Care physician in order to provide adequate care to the community.

Objetivo: El objetivo es proporcionar información actualizada y orientación práctica sobre la terapéutica de la gota en la Atención Primaria de Salud. Métodos: Se estudiaron las guías clínicas, revisiones sistemáticas, meta-análisis y estudios originales publicados entre el 1 de enero de 2011 y el 31 de diciembre de 2016, en el inglés, portugués y español. Resultados: Los fármacos de primera línea en el tratamiento de la gota aguda son anti-inflamatorios no-esteroides, la colchicina y los corticosteroides, solos o en combinación. En la gota crónica son utilizados hipouricemiantes, y el alopurinol es lo fármaco de primera línea. Febuxostat y uricosúricos son alternativas al alopurinol en los casos de intolerancia o ineficacia. Se recomienda la profilaxis de las crisis agudas en el tratamiento hipouricemiante durante al menos 6 meses. No se recomienda el tratamiento de la hiperuricemia asintomática. Conclusión: La terapéutica de la gota debe formar parte de las competencias de un médico especialista en Atención Primaria de Salud a fin de proporcionar la atención adecuada a la comunidad.

Diagnosis and Treatment of Inflammatory Joint Disease / 대한고관절학회지

Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.

The potential renoprotection of xanthine oxidase inhibitors: Febuxostat versus allopurinol

No abstract available.

Renoprotective effects of febuxostat compared with allopurinol in patients with hyperuricemia: A systematic review and meta-analysis

BACKGROUND: Hyperuricemia is reported to be related to rapid progression of renal function in patients with chronic kidney disease (CKD). Allopurinol, a uric acid lowering agent, protects renal progression. However, it is not widely used in patients with CKD because of its serious adverse event. Febuxostat can be alternatively used for patients who are intolerable to allopurinol. We aimed to determine renoprotective effect and urate-lowering effect between the two drugs. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials to assess the effects of febuxostat compared to allopurinol in patients with hyperuricemia. MEDLINE, Embase, and Cochrane Library databases were searched to identify research publications. RESULTS: Four relevant publications were selected from among 3,815 studies. No significant differences were found in the changes in serum creatinine from baseline between the febuxostat and allopurinol groups. Changes in estimated glomerular filtration rate (eGFR) were observed between the two groups at 1 month (mean difference 1.65 mL/min/1.73 m², 95% confidence interval [CI] 0.38, 2.91 mL/min/1.73 m²; heterogeneity χ² = 1.25, I² = 0%, P = 0.01); however, the changes in eGFR were not significantly different at 3 months. A significant difference did exist in the changes in albuminuria levels from baseline between the febuxostat and allopurinol groups (mean difference −80.47 mg/gCr, 95% CI −149.29, −11.64 mg/gCr; heterogeneity χ² = 0.81, I² = 0%, P = 0.02). A significant difference was also observed in the changes in serum uric acid from baseline between the febuxostat and allopurinol groups (mean difference −0.92 mg/dL, 95% CI −1.29, −0.56 mg/dL; heterogeneity χ² = 6.24, I² = 52%, P < 0.001). CONCLUSION: Febuxostat might be more renoprotective than allopurinol.

Prevalence and possible causes of hypouricemia at a tertiary care hospital

BACKGROUND/AIMS: We aimed to investigate the prevalence and possible causes of hypouricemia in the Korean population and to compare our findings with published results of other populations. METHODS: We examined the serum uric acid levels of 30,757 subjects who had their uric acid values measured at least once during a 1-year period. All individuals with hypouricemia (serum uric acid < 2.0 mg/dL, n = 424) were reviewed with respect to medical drug history and concomitant diseases previously identified as being associated with hypouricemia. RESULTS: The prevalence of hypouricemia was 4.14% (299/7,223) among inpatients and 0.53% (125/23,534) among outpatients, for an overall prevalence of 1.39% (424/30,757). Possible causes associated with hypouricemia were found to be solid or hematologic malignancies (n = 86), diabetes mellitus (n = 56), and therapeutic drugs (n = 29). The medications were allopurinol (n = 11), angiotensin II receptor blockers (n = 10), salicylates (n = 6), febuxostat (n = 1), and warfarin (n = 1). In the remaining 226 individuals, the cause of hypouricemia was not identified. CONCLUSIONS: Hypouricemia is relatively common in the Korean population compared to those of other countries. The possible causes associated with hypouricemia are related to underlying diseases and medications.

Comparative Efficacy and Safety of Febuxostat and Allopurinol in the Treatment of Hyperuricemia: A Bayesian Network Meta-analysis

OBJECTIVE: The aim of this study was to assess the relative urate-lowering efficacy and safety of febuxostat and allopurinol in hyperuricemic patients with or without gout. METHODS: Randomized controlled trials (RCTs) examining the efficacy and safety of febuxostat compared to allopurinol or placebo in hyperuricemic patients with/without gout were included in this Bayesian network meta-analysis. RESULTS: Eight RCTs including 4,099 patients met the inclusion criteria. The number of subjects achieving a serum urate (sUA) level <6.0 mg/dL was significantly higher in the febuxostat 120 mg and 80 mg groups than in the allopurinol (100 to 300 mg) group (odds ratio [OR] 7.17, 95% credible interval [CrI] 3.86 to 14.09; OR 3.49, 95% CrI 1.97 to 5.91, respectively). However, achievement of the target sUA level was comparable between febuxostat 40 mg and allopurinol. Ranking probability based on surface under the cumulative ranking curve (SUCRA) indicated that febuxostat 120 mg had the highest probability of being the best treatment for achieving the target sUA (SUCRA=0.9973), followed by febuxostat 80 mg (SUCRA=0.752), febuxostat 40 mg (SUCRA=0.4289), allopurinol (SUCRA=0.3217), and placebo (SUCRA=0). In contrast, no significant difference in safety based on the number of withdrawals due to adverse events was observed among the 5 interventions. CONCLUSION: Febuxostat 80 mg and 120 mg were more efficacious than allopurinol (100 to 300 mg), and febuxostat 40 mg and allopurinol were comparable in urate-lowering efficacy. The safety of febuxostat at all doses was comparable with that of allopurinol.

Febuxostat for the Treatment of Chronic Tophaceous Gout in a Patient on Continuous Ambulatory Peritoneal Dialysis / 대한내과학회지

Hyperuricemic patients with gouty arthritis or tophi, a serum uric acid concentration of 8.0 mg/dL or higher, and complications should be treated with urate-lowering drugs. Conventionally, allopurinol is used to treat hyperuricemia and gout, but it is necessary to adjust the dosage according to the degree of renal impairment. Uncommonly, allopurinol may have severe or fatal side effects. The non-purine xanthine oxidase inhibitor febuxostat undergoes hepatic metabolism and may require less dose adjustment in association with renal function. It is considered to be an alternative treatment for hyperuricemic patients with chronic kidney disease. Our experience suggests that low-dose febuxostat is a promising alternative to allopurinol for the treatment of gouty arthritis or tophi in peritoneal dialysis patients.

Urate lowering efficacy of febuxostat versus allopurinol in hyperuricemic patients with gout

BACKGROUND: The prescribed maximum dose of allopurinol is 300 mg/day to maintain a serum uric acid (sUA) concentration of OBJECTIVE: To determine the efficacy and safety of febuxostat compared with allopurinol in lowering sUA level in patients with hyperuricemia in gout with a baseline sUA ? 8 mg/ dl.DATA SOURCES: Electronic searches through COCHRANE, EMBASE, PUBMED, and Manual Search. Search terms included the following: febuxostat, allopurinol, hyperuricemia, gout.STUDY SELECTION: Randomized, double-blinded, parallel-group clinical trials with meta-analysis quality scale of A-B were included. Intervention included administration of febuxostat and allopurinol in determined dosagesand duration in    each study.ANALYSIS: All outcomes were examined using the random effects model. Dichotomous data were analyzed by calculating the odds ratio, with 95% confidence interval and a significant p value of 0.1 was used.RESULTS: Pooled data showed significant decrease in sUA level from baseline with febuxostat 80 mg than with allopurinol with OR 0.31 (95% CI, 0.24-0.39, p = 0.00001). The risk of developing any adverse event with allopurinol is greater compared to febuxostat with RR 0.90 (95% CI, 0.84-0.96, p = 0.002).CONCLUSION: Febuxostat has significant urate lowering efficacy than allopurinol, and in patients with renal impairment without requiring dose adjustment, with lower incidence of any adverse events. However, elevated liver enzymes brought about by febuxostat were noted.

A model-based meta-analysis to compare urate-lowering response rate of febuxostat and allopurinol in gout patient / 药学学报

This study aims to compare the urate-lowering response rate of febuxostat and allopurinol in gout patient using a model-based meta-analysis. The literature search identified 22 clinical trials of gout with a total of 43 unique treatment arms that met our inclusion criteria, and a total of 6 365 gout patients were included in the study. The response rates of allopuriol and febuxostat were characterized by Tmax model and Emax model respectively, and the effect of baseline serum uric acid (sUA) and patient type on the drug effect was tested. The results showed that allopurinol can reach an average maximum response rate of 50.8% while febuxostat can reach a 100% response rate within a very short time, and the ED50 was 34.3 mg. Covariate analysis revealed that baseline sUA has a negative effect on response rate of allopurinol, and a positive effect on the predicted ED50 of febuxostat. For patients who had shown inadequate response to prior allopurinol treatment, the average response rate was about half that of the allopurinol responder patients.

The Urate-lowering Efficacy and Safety of Febuxostat in Korean Patients with Gout

OBJECTIVE: To compare the urate-lowering efficacy and the safety of febuxostat, allopurinol and placebo in Korean patients with gout for 4 weeks. METHODS: Subjects (n=182) with gout were randomized to febuxostat (40, 80, 120 mg), allopurinol 300 mg, or placebo group. The primary end point was the proportion of subjects whose serum urate concentration fell to less than 6.0 mg/dL after the 4-week treatment. RESULTS: The primary end point was reached at 25.7%, 80.0% and 83.3% of patients receiving 40, 80 and 120 mg of febuxostat, respectively, 58.3% of those receiving 300 mg of allopurinol and none of the placebo (p<0.001: each febuxostat dose or allopurinol group versus placebo group, p=0.0484 and p=0.0196: febuxostat 80 and 120 mg compared with allopurinol, respectively). The number and proportion of subjects who developed adverse events (AEs) were 13 subjects (37%), 14 (39%) and 18 (50%) in the febuxostat of 40, 80 and 120 mg group, respectively, 21 (57%) in the allopurinol 300 mg group and 17 (46%) in the placebo group. No statistically significant differences in the incidence rates of adverse events were observed between the groups. There was no significant difference in gout flare-up incidence. CONCLUSION: Febuxostat, 80 mg or 120 mg, was more effective than allopurinol (300 mg) or placebo, when lowering the serum urate. The safety of febuxostat and allopurinol was comparable.

The Efficacy and Safety of Febuxostat in Korean Patients with Gout

No abstract available.

Recent Progress in the Management of Gouty Arthritis and Hyperuricemia / 대한내과학회지

There is an increasing incidence of gout and hyperuricemia worldwide. It is because the population is getting older, their life style is sedentary, and they take protein-enriched food. Gout is one of the most common but best controllable chronic diseases of adult. There have been recent advances in the understanding of underlying mechanisms and treatment of gout and hyperuricemia. This article is aimed to provide the practical review of the currently recommended practice of care and also to introduce some recently approved drugs. The management concept of hyperuricemia is changing because not only the gout but also the hyperuricemia appear to be independent risk factors for hypertension, renal disease and cardiovascular disease. Gout causes a significant individual and social burden and loss of working force. Still hyperuricemia in the gout patient is often under-treated by the patients themselves and by the physicians also. Once the acute gout attack is controlled, patients should be followed with goal-oriented treatment of hyperuricemia and other risk factors. Allopurinol has remained as a first-line treatment for chronic hyperuricemia, but uricosuric agents may also be considered in some patients. These drugs have provided good control of the disease in most gout patients until now but the elderly patients with gout often carry co-medications, contra-indication to these drugs, and risk of adverse drug reaction. Febuxostat is a nonpurine xanthine-oxidase inhibitor. It is a new agent approved by the US FDA and Korean FDA for the treatment of hyperuricemia in patients with gout which may be used when allopurinol is not tolerated or contraindicated. Pegloticase is the PEGylated urate oxidase which is very potent and so recently approved by the US FDA for the gout refractory to conventional treatment.

Updates in the management of gouty arthritis / 대한내과학회지

Gout is the most common inflammatory arthritis in men over 40 years old and the prevalence is increasing. Asymptomatic hyperuricemia is predisposing condition of gout but the frequency of progression to acute gout is not high enough to need prophylactic treatment. In acute gout flare, first line therapy is non-steroid anti-inflammatory agents (NSAIDs) or corticosteroids, depending on comorbidities. Colchicine is now second line therapy. Urate lowering therapy for gout needs to be initiated when the second attack occurs in a year. Allopurinol, a xanthine oxidase inhibitor, has been the most widely used agent for the treatment of chronic gout. Now, febuxostat has emerged as a new xanthine oxidase inhibitor that is expected to be useful in patients with mildly decreased renal function. Uricosuric agents are alternative therapies for patients with preserved renal function and no history of nephrolithiasis. During urate lowering therapy, the dose should be titrated upward until the serum uric acid level is kept less than 6mg/dL. When initiating urate lowering therapy, concurrent prophylactic therapy with NSAIDs or low dose colchicine for more than six months is recommended for reducing flare-ups. In chronic gout treatment, dietary modification seems to have minimal effect, but alcohol drinking and weight control can be recommended.