Why is febuxostat better than allopurinol?

The cardiovascular safety of febuxostat compared to allopurinol for treating gout remains equivocal. Febuxostat had a better safety outcome compared with allopurinol[1].

Gout is a common clinical metabolic system disease and may contribute to many adverse health events. Evidence shows that the risk of hyperuricemia increases with advanced age in both sexes. Studies have found that treating gout with xanthine oxidase inhibition (allopurinol, febuxostat) can increase uric acid excretion via the kidneys and achieve better results[2].

Febuxostat, a novel non‐purine selective inhibitor of xanthine oxidase (XO), is more effective than allopurinol in lowering uric acid levels in patients with hyperuricemia and gout. Febuxostat is a urate‐lowering drug that was approved for the management of gout by the EMA, the US FDA and the China FDA (CFDA). It is beneficial in patients who are refractory or intolerant to allopurinol and requires no dose limitation in stages 1–3 of chronic kidney disease. The study suggests that compared with allopurinol, the use of febuxostat results in significantly decreased risks of urgent coronary revascularization and stroke. Initiation of febuxostat did not increase the risk of nonfatal myocardial infarction, the cardiovascular related mortality and all‐cause mortality. Subgroup analyses according to age, population and study design showed that the febuxostat treatment could significantly reduce the occurrence of stroke in patients aged≥65 years and white race (≥70%).

References

[1] Linggen Gao MD. “Cardiovascular safety of febuxostat compared to allopurinol for the treatment of gout: A systematic and meta-analysis.” Clinical Cardiology 44 7 (2021): 907–916.

[2] Meijiao Wang. “The major cardiovascular events of febuxostat versus allopurinol in treating gout or asymptomatic hyperuricemia: a systematic review and meta-analysis.” Annals of palliative medicine (2021): 10327–10337.

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