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Risk of Major Adverse Cardiovascular Events in Patients Treated with Febuxostat Compared to Allopurinol: A Systematic

Andri Reza Rahmadi1, Alqa Fauzan Syahreza2, Annisya Diva Shafira2

  • 1Department of Internal Medicine, Universitas Padjadjaran, Bandung, Indonesia.

Current Rheumatology Reviews
|July 28, 2026
PubMed

Insights

This meta-analysis found febuxostat and allopurinol have similar cardiovascular safety in gout patients. No significant differences in major adverse cardiovascular events (MACE) were observed between the two treatments.

Area of Science:

  • Cardiology
  • Pharmacology
  • Rheumatology

Background:

  • Gout and hyperuricemia management often involves urate-lowering therapies.
  • Cardiovascular safety is a critical consideration for these treatments.

Purpose of the Study:

  • To compare the cardiovascular safety of febuxostat versus allopurinol.
  • To assess outcomes related to Major Adverse Cardiovascular Events (MACE).

Main Methods:

  • Systematic review and meta-analysis of RCTs and observational studies.
  • Searched PubMed and Scopus up to September 2025.
  • Included 11 studies with over 3.5 million participants.

Main Results:

  • No statistically significant difference in MACE risk between febuxostat and allopurinol.
  • Similar safety profiles for myocardial infarction, cardiovascular mortality, heart failure, and stroke.
  • Significant heterogeneity observed across outcomes.

Conclusions:

  • Febuxostat demonstrates non-inferiority to allopurinol regarding major cardiovascular endpoints.
  • Findings align with existing large-scale trials and observational data.
  • Heterogeneity highlights the need to consider study design and patient characteristics.
Abstract

Keywords:
FebuxostatMACEallopurinolcardiovascular safetygouthyperuricemia

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