Reduced gout flares with stepwise dose increase of febuxostat during the initial introduction of urate-lowering therapy / 中华风湿病学杂志

ABSTRACT

Objective:To investigate whether febuxostat with stepwise dose increase is as useful as colchicine prophylaxis in comparison with febuxostat with no dose titration when initial introduction of urate-lowering therapy in patients with gout. And to determine the effect of urate-lowering therapy in the treat to target by febuxostat with stepwise dose increase.Methods:In this prospective, multicentre, randomized open-label comparative study, patients were randomized to group A (stepwise dose increase of febuxostat from 10 to 40 mg/d), group B (fixed-dose febuxostat 40 mg/d plus colchicine 0.5 mg/d) or group C (fixed-dosefebu-xostat 40 mg/d) and were followed-up for 24 weeks. Non-steroidal anti-inflammatory drug was used to control symptoms when acute flare occurred. Patients were follow-up every 4 weeks. The comparison between groups was made by single factor analysis of variance (ANOVA). χ2 test was used to compare groups. Results:A total of 276 patients were randomized, and 253 patients were treated. 211 patients completed the study and were follow-up. Among the treated patients, gout flares were experienced by 12/84(25.0%) in group A, 20/85(23.5%) in group B and 26/42 (61.9%) in group C. There was no significant difference between group A and group B ( χ2=0.050, P=0.824) in gout flares. There was significantly higher frequency in gout flares in group C than that in group A and group B ( χ2=22.040, P<0.01). The proportion of patients reaching the target of urate-lowering therapy in group A at 4 and 8 weeks was significantly lower than that in group B and C. And there was no significant difference among the three groups after 12 weeks. Conclusion:Stepwise dose increase of febuxostat and low-dose colchicine has the same prophylaxis effectiveness in reducing gout flares but are more effective in prevent acute flare when compared with fixed-dose febuxostat alone. Stepwise dose increase of febuxostat may be an effective alternative to low-dose colchicine prophylaxis during the introduction of urate-lowering therapy.