Volume 30, Issue 6 p. 594-608

Urate-Lowering Therapy for Gout: Focus on Febuxostat

Bryan L. Love Pharm.D.

Corresponding Author

Bryan L. Love Pharm.D.

Wingate University School of Pharmacy, Wingate, North Carolina.

visit http:www.atypon-link.comPPIloiphco. For questions or comments, contact Bryan L. Love, Pharm.D., BCPS, Wingate University School of Pharmacy, 316 North Main Street, Box 3087, Wingate, NC 28174; e-mail: [email protected].Search for more papers by this author
Robert Barrons Pharm.D.

Robert Barrons Pharm.D.

Wingate University School of Pharmacy, Wingate, North Carolina.

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Angie Veverka Pharm.D.

Angie Veverka Pharm.D.

Wingate University School of Pharmacy, Wingate, North Carolina.

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K. Matthew Snider Pharm.D.

K. Matthew Snider Pharm.D.

Wingate University School of Pharmacy, Wingate, North Carolina.

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First published: 06 January 2012
Citations: 77

Abstract

Gout is a common, painful, and often debilitating rheumatologic disorder that remains one of the few arthritic conditions that can be diagnosed with certainty and cured with appropriate therapy. Allopurinol is the most frequently prescribed agent for gout in the United States. Unfortunately, most patients treated with allopurinol do not achieve target serum uric acid (sUA) levels, possibly due to a perceived intolerability to allopurinol in doses above 300 mg and the need for reduced doses in patients with renal insufficiency. Febuxostat, an orally administered, nonpurine inhibitor of xanthine oxidase, was recently approved by the U.S. Food and Drug administration for chronic management of hyperuricemia in patients with gout. Patients treated with febuxostat achieve rapid and substantial reductions in sUA levels. Compared with allopurinol-treated patients, patients receiving febuxostat 80 mg/day were more likely to achieve sUA concentrations less than 6 mg/dl. In long-term studies (up to 5 yrs), febuxostat demonstrated sustained reductions in sUA levels, nearly complete elimination of gout flares, and a frequency of adverse effects comparable to allopurinol. The most commonly reported adverse effects were liver function abnormalities, rash, nausea, and arthralgias. The recommended starting dose of febuxostat is 40 mg/day, which may be increased to 80 mg/day after 2 weeks if patients do not achieve sUA levels less than 6 mg/dl. Dosage adjustment in mild-to-moderate renal insufficiency is unnecessary; however, data are lacking on the safety of febuxostat in patients with severe renal impairment. Although more costly than allopurinol, febuxostat appears to be an acceptable alternative for the treatment of gout and hyperuricemia, and may be advantageous in patients with renal impairment, intolerance to allopurinol, or the inability to attain sUA levels less than 6 mg/dl despite adequate therapy with available agents.