Febuxostat for the chronic management of hyperuricemia in patients with gout

ABSTRACT

Febuxostat is a non-purine, selective inhibitor of both isoforms of xanthine oxido-reductase (XOR), and a major alternative to the scarce number of urate-lowering medications available in the last decades. Its inhibition of XOR is more potent than allopurinol in a mg to mg comparison, what is associated to achievement of serum urate target more frequently than allopurinol at doses tested in clinical trials, especially in patients with the highest baseline serum urate levels. Its pharmacokinetics is not greatly dependent on renal clearance, contrary to allopurinol, what may be an advantage in patients with chronic kidney disease. Several trials are further evaluating both the cardiovascular safety of febuxostat and its possible beneficial effect on renal function preservation. Still scarce, but clinically interesting, evidence on its use in transplant patients has been recently released.

KEYWORDS:

• Gout
• hyperuricemia
• febuxostat
• allopurinol
• chronic kidney disease
• cardiovascular disease

Aknowledgements

The authors would like to thank Nuria Perez-Herrero, from the Medicine & Odontology University School, University of the Basque Country, for her contribution to literature and trials search.

Declaration of interest

F Perez-Ruiz disclosures: Advisor for AstraZeneca, Cimabay and Menarini; lectures for AstraZeneca and Menarini; educational material preparation for AstraZeneca and Menarini; investigation grants from Fundación Española de Reumatología, Ministerio de Sanidad –Gobierno de España-, Departamento de Industria e Innovación – Gobierno Vasco-, and Asociación de Reumatólogos el Hospital de Cruces. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.