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Gout treatment: febuxostat and allopurinol

A recent study in the NEJM describes the outcome of a large clinical trial that compared cardiovascular risks of febuxostat or allopurinol for gout treatment.

Gout is a kind of arthritis that occurs due to the formation of urate crystals within the bone joints. Uric acid, a substance found in certain food products, is typically excreted from the body by the kidney. However, disturbances in uric acid metabolism can lead to the formation of urate crystals in the joints. The symptoms include a sudden onset of pain, swelling, redness, and tenderness in the joints of the patients.

Many different uric-acid reducing drugs such as allopurinol, febuxostat, and probenecid are currently being used for the treatment of gout. People suffering from gouts are also thought to have a higher risk for cardiovascular diseases. A recent trial established if febuxostat use in gout patients is linked to a higher cardiovascular risk in comparison to allopurinol. The results were published in the New England Journal of Medicine.

The trial included more than 6,000 patients from over 320 centers across North America that were followed for an average 32 months. The gout patients were treated either with 40-80 mg of febuxostat or 200-600 mg of allopurinol. The study aimed to ascertain the frequency of cardiovascular events in these two patients groups.

The results indicated that the overall the incidence of cardiovascular events did not differ significantly in patients treated with these two drugs. Whereas the incidence of cardiovascular risk in allopurinol group was 10.8%, the corresponding value for febuxostat was 10.4%.

However, the number of fatalities occurring due to cardiovascular events was significantly higher in febuxostat group (4.3% to 3.2%). The study also identified interactions with other NSAID pain medications. The authors commented that one major limitation of the study was the loss of follow-up patients in both groups – a factor that could affect the outcome of the study.

Overall, the study found that gout patients treated with febuxostat had similar rates of major cardiovascular events to gout patients treated with allopurinol. However, there were more cases of all-cause mortality associated with febuxostat.

Written by Vinayak Khattar, Ph.D., M.B.A.

Reference: White WB, Saag KG, Becker MA, et al. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. NEJM. 2018 March 12.

Vinayak Khattar PhD MBA
Vinayak Khattar PhD MBA
Vinayak Khattar completed his Master of Biotechnology at D.Y. Patil University in India. He received his Ph.D. in Cancer Biology at the University of Alabama at Birmingham (UAB) and then completed his M.B.A from the UAB Collat School of Business. His research interests lie in identifying mechanisms that dictate protein stability in cancer cells, immuno-oncology, and bone biology. He has seven peer-reviewed publications, over 40 citations, and three awards. He likes to watch Netflix documentaries with his family during his free time.

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