DOI: https://doi.org/10.22141/1608-1706.2.20.2019.168017

Expanding the boundaries of urate-lowering therapy: place of febuxostat in gout treatment

I.Yu. Golovach, Ye.D. Yehudina

Abstract


Gout is a chronic disease requiring the appointment of a permanent urate-lowering therapy. The gold standard of such therapy is allopurinol. Over the last decade, a new drug, febuxostat, a selective xanthine oxidase inhibitor, namely xanthine reductase, has appeared in the doctors’ arsenal. The article reviewed the literature on the main clinical studies of this drug, which showed its effectiveness, comparable or exceeding the effectiveness of allopurinol, and also demonstrated its possible appointment to patients with reduced kidney function, with an allergic reaction or resistance to allopurinol, that significantly improves the prognosis. Elderly patients, patients with mild or moderate kidney failure (glomerular filtration rate 30–89 ml/min), mild and moderate hepatic insufficiency do not require febuxostat dose adjustment, which greatly expands the possibilities of using this drug to achieve the target levels of uric acid. The article discusses the cardio-safety of the urate-lowering therapy, first of all of febuxostat, as well as assesses the results of the last known researches on cardiovascular safety of allopurinol and febuxostat. The algorithms of choice of preparation for the starting therapy of gout in case of intolerance of allopurinol, cardiovascular diseases, renal dysfunction are presented. Patients with contraindications to allopurinol should start treatment with uricosuric agent or febuxostat, in accordance with their concomitant diseases. If the target uricemia is not achieved after a gradual increase in dose to the maximum permissible one, a doctor should discuss with the patient a combination of febuxostat with uricosuric agent.

Keywords


gout; hyperuricemia; uric acid; urate-lowering therapy; treatment; safety; allopurinol; febuxostat; review

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