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The role of febuxostat in gout

Thomas Bardin1,2,3, Pascal Richette1,2,3

  • 1Department of Rheumatology, Hôpital Lariboisière, APHP.

Current Opinion in Rheumatology
|January 3, 2019
PubMed

Insights

Febuxostat use in gout patients with cardiovascular disease showed a higher risk of cardiovascular death compared to allopurinol. Guidelines for gout management should be revised, prioritizing allopurinol or uricosurics over febuxostat in certain patients.

Area of Science:

  • Cardiology
  • Rheumatology
  • Pharmacology

Background:

  • Cardiovascular safety concerns surround febuxostat, a urate-lowering drug used in gout management.
  • Gout management requires careful consideration of drug safety, especially in patients with pre-existing cardiovascular conditions.

Purpose of the Study:

  • To evaluate the cardiovascular safety of febuxostat compared to allopurinol in patients with gout and major cardiovascular disease.
  • To inform revised clinical guidelines for gout management based on new safety data.

Main Methods:

  • The Cardiovascular Safety of Febuxostat and Allopurinol in Gout (CARES) trial was a randomized controlled trial.
  • Approximately 6190 patients with gout and cardiovascular disease were randomized to febuxostat or allopurinol.
  • Patients were followed for a median of 32 months to assess cardiovascular outcomes.

Main Results:

  • No significant difference was observed in the composite primary endpoint between febuxostat and allopurinol.
  • However, cardiovascular death was significantly more frequent in the febuxostat group (4.3%) compared to the allopurinol group (3.2%) (P=0.03).

Conclusions:

  • Current guidelines for gout management require revision due to the increased cardiovascular death risk associated with febuxostat.
  • Allopurinol is recommended as the first-line urate-lowering drug for gout patients without contraindications.
  • In patients with cardiovascular disease/risk factors and no history of uric acid stones, uricosurics may be preferred over febuxostat if allopurinol is contraindicated.
Abstract

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