Febuxostat better than allopurinol for urate lowering

Wednesday, 13 May 2015

Another study finds febuxostat is better and quicker at lowering urate levels compared to allopurinol, but the allopurinol doses used in the study may have been sub-optimal, researchers say.

The observational industry sponsored study of more than 2,000 matched patients taking febuxostat and 14,025 taking allopurinol found that a significantly higher proportion of patients taking febuxostat achieved an sUA of <5.0 mg/dl (36.2% vs. 21.8%) or an sUA <6.0 mg/dl (58.5% vs. 47.1%).

Patients receiving febuxostat (mostly at doses of 40 mg/day) achieved target sUA in one month earlier than allopurinol-treated (mostly 300 mg daily or lower) patients, a finding which according to the authors was statistically and clinically significant.

However they noted that their study provided evidence for the most commonly used doses of allopurinol, and not all allopurinol doses.

“It is likely that allopurinol dose of 300 mg/day is subtherapeutic in many patients with gout; lower allopurinol doses <300 mg/day may be even more likely to be subtherapeutic,” they said. 

Nevertheless the findings help inform patients and physicians when they are making a choice regarding the treatment of hyperuricemia said the authors, noting that the cost differences between the two treatments should be taken into account.

“It is likely that individualized patient-physician decision-making that incorporates these data along with the risk of medication side effects and costs will lead to a more informed decision and a more satisfied patient,” they said.

This month the PBAC recommended a listing for febuxostat as a second-line treatment for chronic symptomatic gout. It was turned down in 2014 as a first line treatment as the PBAC considered that the advantage of a faster reduction in serum uric acid (sUA) did not translate into benefits over allopurinol for more clinically meaningful outcomes such as flare reduction, tophi resolution or health-related quality of life.

The study was funded by Takeda Pharmaceuticals International. 

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