Selection problem of urate-lowering drug in gout

Selection problem of urate-lowering drug in gout

E.V. Zhilyaev^1-3, E.G. Zhilyaev¹, A.A. Klimenko¹ 

¹Pirogov Russian National Research Medical University, Moscow

²European Medical Center, Moscow

³Russian Medical Academy of Continuous Professional Education, Moscow 

Gout is a disease that occurs due to the monosodium urate deposition and inflammation provoked by these crystals. Urate-lowering therapy in considered fundamental for patients with gout. Only two urate-lowering drugs are available in the Russian Federation: allopurinol and febuxostat. The urate-lowering ability of febuxostat at doses of 80 mg/day and 120 mg/day exceeds that of allopurinol at a fixed dose of 300 mg/day. However, it seems to be impossible to discuss the comparative efficacy of the titrated doses of febuxostat versus allopurinol (up to 900 mg/day) due to a lack of data. Febuxostat is not inferior to allopurinol in its ability to prevent serious cardiovascular events. Switching from a titrated dose of allopurinol to febuxostat at a dose of 80 mg/day, followed by a possible dose increase to 120 mg/day is safe. Treatment with allopurinol at a fixed dose is accompanied by a greater risk of hypersensitivity reactions versus febuxostat. Although, there is no convincing evidence of differences in the case of a gradual dose increase of allopurinol. Given the currently available evidence base, febuxostat and allopurinol can be regarded as equivalent urate-lowering drugs.

Keywords: febuxostat, allopurinol, hyperuricemia, gout, uric acid, kidney failure, cardiovascular risk.

For citation: Zhilyaev E.V., Zhilyaev E.G., Klimenko A.A. Selection problem of urate-lowering drug in gout. RMJ. 2023;7:16–20.