Febuxostat for Treatment of Chronic Gout

Charnelda L. Gray, Pharm.D., BCPS; Nafesa E. Walters-Smith, Pharm.D., BCPS

Disclosures

Am J Health Syst Pharm. 2011;68(5):389-398. 

In This Article

Role in Therapy

Febuxostat 40 mg daily appears to be as efficacious as allopurinol in lowering serum uric acid levels.[38] Both febuxostat 40 and 80 mg can be given to patients with mild-to-moderate renal impairment (CLcr of 30–89 mL/min) without dosage adjustments and are as effective as allopurinol in achieving the serum uric acid level of <6.0 mg/dL in patients with renal impairment.[30,31,37,38] There do not appear to be any significant advantages in the use of febuxostat over allopurinol in patients who already experience adequately lowered serum uric acid levels with allopurinol. Febuxostat is generally well tolerated but is significantly more expensive than allopurinol. Febuxostat is a second-line option for patients with gout who are unable to take allopurinol due to hypersensitivity, intolerance, or lack of efficacy in achieving a target serum uric acid concentration of <6.0 mg/dL.

There may be additional uses in individuals with concurrent renal function impairment; however, more data need to be provided on dosage titration in renal impairment. Febuxostat may also be an alternative therapy for patients with allopurinol sensitivity or those who are not candidates for uricosuric therapy with probenecid. Evaluation of rates of discontinuation and documented adverse effects, primarily cardiovascular events, compared with current therapeutic options provides reason for pause in the placement of febuxostat as a first-line agent. Additional studies are needed to evaluate if and to what degree febuxostat displaces other highly protein-bound drugs and its potential long-term effects on hepatic function. Trials that include dosage increases for allopurinol would also provide details relative to comparative efficacy with febuxostat. Febuxostat is not recommended for the treatment of patients with secondary hyperuricemia, such as those being treated for Lesch-Nyhan syndrome or cancer or those receiving organ transplants.[30]

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