Safety profile of anti-gout agents: an update

Recent interest in gout has led to development of new drugs for acute gout and long-term urate-lowering, as well as interest in improving the use of older drugs. The patients' comorbidities and concomitant medications may contribute to the risk of adverse drug reactions with anti-gout therapies. This review will highlight recent data on the safety of drugs used in gout.

Colchicine has a narrow therapeutic index, and low doses are effective with less gastrointestinal toxicity. There are significant interactions between colchicine and CYP3A4 and P-glycoprotein inhibitors, and the colchicine dose must be reduced. Allopurinol and febuxostat have similar adverse effect profiles. Recent data have highlighted the risk association of HLA-B5801 in some ethnic groups and of allopurinol starting dose in allopurinol hypersensitivity syndrome. Further long-term cardiovascular safety data in patients with cardiovascular disease or cardiovascular risk factors receiving febuxostat and allopurinol are pending. Infusion reactions are common in patients receiving pegloticase, particularly in patients with pre-infusion serum urate above 0.36mmol/l (6 mg/dl).

In general, treatments for gout are well tolerated, although clinicians must keep in mind the potential for drug interactions and the contribution of comorbidities to the potential for adverse effects with gout therapies.