Febuxostat initiation not associated with prolonged acute gout flares: Study
China: Febuxostat initiation during an acute gout flare does not lead to prolonged duration of acute flares, finds a recent study. According to the study, published in the journal Rheumatology, patients who were administered febuxostat had a lower serum uric acid (sUA) levels and a lower rate of recurrent gout flares.
Gout is a form of arthritis that results from the deposition of monosodium urate (MSU) crystal. For gout patients, urate-lowering treatment (ULT) is essential. Generally, ULT initiation is recommended after the resolution of acute flare to avoid prolongation of symptoms. The incidence of gout flares is positively associated with reduction of sUA in the first few months after initiating ULT.
Previous small randomized clinical trials have shown that initiating allopurinol treatment during an acute gout flare did not prolong painful gout flares. Febuxostat (40 mg/day) was found to have a superior urate-lowering effect compared with limited allopurinol doses (maximum 200–300 mg/day).
Presently, no studies have been published on the febuxostat initiation of acute gout flares. To fill this knowledge gap, Yanying Zhang, University of Chinese Medicine, Shenzhen, and colleagues aimed to to determine whether initiation of febuxostat during an acute gout flare prolongs the current episode.
For the purpose, the researchers performed a randomized, placebo-controlled, single-blinded, multicentre trial. The trial included 140 patients with acute gout flares within 72 h. They were randomized in the ratio 1:1 to the placebo (n=70) and febuxostat (40 mg/day) groups (n=70).
All patients were administered diclofenac (150 mg/day) for 7 days and then open-labelled on the eighth day. Febuxostat 40 mg daily and diclofenac 75 mg daily were administered from day 8 through 28 for the remission period. The dose of diclofenac was 150 mg/day before remission in both arms, and the original protocol was maintained until remission. The primary outcome was 'days to resolution'.
Key findings of the study include:
- The mean days to resolution was 5.98 days [median 7.00, interquartile range (IQR) 2.45 days] for the placebo and 6.50 days (median 7.00, IQR 3.67 days) for the febuxostat group.
- The rate of resolution within 7 days was 84.38% for the placebo group and 76.92% for the febuxostat group.
- There were no statistically significant differences in joint pain, swelling, tenderness and erythema scores at days 1, 3, 5 and 7.
- The mean serum uric acid levels were 507.54 and 362.62 μmol/l for the placebo and febuxostat group, respectively, on day 7.
- The rate of recurrent gout flares was 10.00% for the placebo group and 6.56% for the febuxostat group from day 8 through 28.
"Our findings show that initiation of febuxostat administration during an acute gout flare did not prolong the duration of acute flares," concluded the authors.
The study titled, "Initiation of febuxostat for acute gout flare does not prolong the current episode: a randomized clinical trial," is published in the journal Rheumatology.