No abstract available.
Gout* ; Humans ; Thiazoles ; Febuxostat

No abstract available.
Allopurinol* ; Febuxostat* ; Xanthine Oxidase* ; Xanthine*

OBJECTIVE: The aim of this study was to assess the relative urate-lowering efficacy and safety of febuxostat and allopurinol in hyperuricemic patients with or without gout. METHODS: Randomized controlled trials (RCTs) examining the efficacy and safety of febuxostat compared to allopurinol or placebo in hyperuricemic patients with/without gout were included in this Bayesian network meta-analysis. RESULTS: Eight RCTs including 4,099 patients met the inclusion criteria. The number of subjects achieving a serum urate (sUA) level <6.0 mg/dL was significantly higher in the febuxostat 120 mg and 80 mg groups than in the allopurinol (100 to 300 mg) group (odds ratio [OR] 7.17, 95% credible interval [CrI] 3.86 to 14.09; OR 3.49, 95% CrI 1.97 to 5.91, respectively). However, achievement of the target sUA level was comparable between febuxostat 40 mg and allopurinol. Ranking probability based on surface under the cumulative ranking curve (SUCRA) indicated that febuxostat 120 mg had the highest probability of being the best treatment for achieving the target sUA (SUCRA=0.9973), followed by febuxostat 80 mg (SUCRA=0.752), febuxostat 40 mg (SUCRA=0.4289), allopurinol (SUCRA=0.3217), and placebo (SUCRA=0). In contrast, no significant difference in safety based on the number of withdrawals due to adverse events was observed among the 5 interventions. CONCLUSION: Febuxostat 80 mg and 120 mg were more efficacious than allopurinol (100 to 300 mg), and febuxostat 40 mg and allopurinol were comparable in urate-lowering efficacy. The safety of febuxostat at all doses was comparable with that of allopurinol.
Allopurinol* ; Gout ; Humans ; Hyperuricemia* ; Uric Acid ; Febuxostat

Introduction: Tumor lysis syndrome (TLS) is a therapy-related complication resulting from the rapid lysis of malignant cells post-treatment. The control of serum uric acid level plays a key role in its prevention, thus, allopurinol is used. Febuxostat is a novel xanthine oxidase inhibitor and there are currently no recommendations for using such in the prevention of TLS, hence, this study was conducted. This study aims to determine the efficacy of febuxostat in the prevention of TLS. Methods: Extensive search for randomized controlled trials (RCT) focusing on the use of febuxostat in the prevention of TLS was done. Each article was appraised independently by the researchers. The data were analysed using Rev Man 5.3. Results: Two trials were included in this review. The study results revealed that febuxostat, when compared to allopurinol, was able to decrease serum uric acid as hyperuricemia is the hallmark of TLS. This decrease in serum uric acid was consistent in both studies. Serum uric acid levels at the end of the treatment showed a standard mean difference of -1.09 (95% CI-1.29, -0.88, p for heterogeneity <0.01, p for effect <0.01, I2 = 97%). The trend of both studies favored the efficacy of febuxostat. The adverse effects documented during the study period in both trials were mostly noted from the chemotherapeutic agents and none from the use of febuxostat. Conclusion Febuxostat was shown to be more effective than allopurinol in the prevention of TLS.
Febuxostat ; Tumor Lysis Syndrome ; Meta-Analysis

OBJECTIVE: To compare the urate-lowering efficacy and the safety of febuxostat, allopurinol and placebo in Korean patients with gout for 4 weeks. METHODS: Subjects (n=182) with gout were randomized to febuxostat (40, 80, 120 mg), allopurinol 300 mg, or placebo group. The primary end point was the proportion of subjects whose serum urate concentration fell to less than 6.0 mg/dL after the 4-week treatment. RESULTS: The primary end point was reached at 25.7%, 80.0% and 83.3% of patients receiving 40, 80 and 120 mg of febuxostat, respectively, 58.3% of those receiving 300 mg of allopurinol and none of the placebo (p<0.001: each febuxostat dose or allopurinol group versus placebo group, p=0.0484 and p=0.0196: febuxostat 80 and 120 mg compared with allopurinol, respectively). The number and proportion of subjects who developed adverse events (AEs) were 13 subjects (37%), 14 (39%) and 18 (50%) in the febuxostat of 40, 80 and 120 mg group, respectively, 21 (57%) in the allopurinol 300 mg group and 17 (46%) in the placebo group. No statistically significant differences in the incidence rates of adverse events were observed between the groups. There was no significant difference in gout flare-up incidence. CONCLUSION: Febuxostat, 80 mg or 120 mg, was more effective than allopurinol (300 mg) or placebo, when lowering the serum urate. The safety of febuxostat and allopurinol was comparable.
Allopurinol ; Gout ; Humans ; Incidence ; Thiazoles ; Uric Acid ; Febuxostat

Tophi is one of the clinical manifestations of gout. On the other hand, it does not draw the patient's attention when it is asymptomatic, which leads to delayed management. The current case is a typical example of delayed diagnosis and management. The authors' preferred management of tophi was medical not surgical, even though the hitherto therapeutic issue has been conservative versus surgical. The authors chose conservative treatment in the osteolytic lesion resulting from huge tophi in the patella, and the report the results of 6 years follow-up.
Delayed Diagnosis ; Febuxostat ; Follow-Up Studies ; Gout ; Hand ; Osteolysis ; Patella

OBJECTIVE: To compare efficacy and safety of febuxostat in gouty patients with chronic kidney disease (CKD) stage 3 and stage 4/5. METHODS: Age and sex matched patients with CKD stage 3 and stage 4/5 who were diagnosed with gout were included. The dose of febuxostat was increased according to serum uric acid (sUA) level. Adherence, the number of gout attack, the change of sUA, the change of estimated glomerular filtration rate (eGFR) and adverse events (AEs) were evaluated for 12 months. RESULTS: There were no significant differences in the baseline variables between CKD stage 3 and CKD stage 4/5. Disease duration was longer and baseline sUA was higher in the CKD stage 4/5. There were no significant differences in the mean sUA at the last follow-up, the number of patients who reached the sUA target of 6 mg/dL and the number of gout attack between the groups. There were no significant differences in the change of eGFR and decrease of eGFR between the groups. There were 2 cases of AEs. One patient in CKD stage 3 had maculopapular rash and one patient in CKD stage 4/5 had dizziness. The AEs were subsided after febuxostat was stopped. CONCLUSION: Febuxostat was efficacious and well tolerated in gout patients with CKD stage 4/5.
Dizziness ; Exanthema ; Febuxostat ; Follow-Up Studies ; Glomerular Filtration Rate ; Gout ; Humans ; Renal Insufficiency, Chronic ; Uric Acid

BACKGROUND: The prescribed maximum dose of allopurinol is 300 mg/day to maintain a serum uric acid (sUA) concentration of < 6.0 mg/dl. However, increasing evidence shows that 300 mg dose is ineffective in achieving the target sUA level, limiting allopurinol's use in certain subsets of patients who are intolerant to allopurinol such as patients with chronic kidney disease, with multiple comorbidities and elderly patients.
OBJECTIVE: To determine the efficacy and safety of febuxostat compared with allopurinol in lowering sUA level in patients with hyperuricemia in gout with a baseline sUA ? 8 mg/ dl.
DATA SOURCES: Electronic searches through COCHRANE, EMBASE, PUBMED, and Manual Search. Search terms included the following: febuxostat, allopurinol, hyperuricemia, gout.
STUDY SELECTION: Randomized, double-blinded, parallel-group clinical trials with meta-analysis quality scale of A-B were included. Intervention included administration of febuxostat and allopurinol in determined dosages
and duration in    each study.
ANALYSIS: All outcomes were examined using the random effects model. Dichotomous data were analyzed by calculating the odds ratio, with 95% confidence interval and a significant p value of 0.1 was used.
RESULTS: Pooled data showed significant decrease in sUA level from baseline with febuxostat 80 mg than with allopurinol with OR 0.31 (95% CI, 0.24-0.39, p = 0.00001). The risk of developing any adverse event with allopurinol is greater compared to febuxostat with RR 0.90 (95% CI, 0.84-0.96, p = 0.002).
CONCLUSION: Febuxostat has significant urate lowering efficacy than allopurinol, and in patients with renal impairment without requiring dose adjustment, with lower incidence of any adverse events. However, elevated liver enzymes brought about by febuxostat were noted.

Hyperuricemia ; Allopurinol ; Uric Acid ; Febuxostat ; Comorbidity ; Gout ; Thiazoles ; Renal Insufficiency, Chronic ; Information Storage And Retrieval ; Liver

BACKGROUND/AIMS: We aimed to investigate the prevalence and possible causes of hypouricemia in the Korean population and to compare our findings with published results of other populations. METHODS: We examined the serum uric acid levels of 30,757 subjects who had their uric acid values measured at least once during a 1-year period. All individuals with hypouricemia (serum uric acid < 2.0 mg/dL, n = 424) were reviewed with respect to medical drug history and concomitant diseases previously identified as being associated with hypouricemia. RESULTS: The prevalence of hypouricemia was 4.14% (299/7,223) among inpatients and 0.53% (125/23,534) among outpatients, for an overall prevalence of 1.39% (424/30,757). Possible causes associated with hypouricemia were found to be solid or hematologic malignancies (n = 86), diabetes mellitus (n = 56), and therapeutic drugs (n = 29). The medications were allopurinol (n = 11), angiotensin II receptor blockers (n = 10), salicylates (n = 6), febuxostat (n = 1), and warfarin (n = 1). In the remaining 226 individuals, the cause of hypouricemia was not identified. CONCLUSIONS: Hypouricemia is relatively common in the Korean population compared to those of other countries. The possible causes associated with hypouricemia are related to underlying diseases and medications.
Allopurinol ; Angiotensin Receptor Antagonists ; Diabetes Mellitus ; Febuxostat ; Hematologic Neoplasms ; Humans ; Inpatients ; Outpatients ; Prevalence* ; Salicylates ; Tertiary Healthcare* ; Uric Acid ; Warfarin

This study aims to compare the urate-lowering response rate of febuxostat and allopurinol in gout patient using a model-based meta-analysis. The literature search identified 22 clinical trials of gout with a total of 43 unique treatment arms that met our inclusion criteria, and a total of 6 365 gout patients were included in the study. The response rates of allopuriol and febuxostat were characterized by Tmax model and Emax model respectively, and the effect of baseline serum uric acid (sUA) and patient type on the drug effect was tested. The results showed that allopurinol can reach an average maximum response rate of 50.8% while febuxostat can reach a 100% response rate within a very short time, and the ED50 was 34.3 mg. Covariate analysis revealed that baseline sUA has a negative effect on response rate of allopurinol, and a positive effect on the predicted ED50 of febuxostat. For patients who had shown inadequate response to prior allopurinol treatment, the average response rate was about half that of the allopurinol responder patients.
Allopurinol ; therapeutic use ; Febuxostat ; Gout ; blood ; drug therapy ; Gout Suppressants ; therapeutic use ; Humans ; Thiazoles ; therapeutic use ; Uric Acid ; blood