Gout management by urate lowering therapies
Gout epitomizes the most common inflammatory joint disease affecting majority of the population. Serum uric acid concentrations should not go above 6 mg/dl in patients with gout. In fact, it must be below 5 mg/dl in patients with severe gout.
Urate lowering medications (ULMs) are generally used to achieve the desired concentration of urate level in patients suffering from gout. Xanthine oxidase inhibitors like allopurinol, febuxostat and uricosuric agents are amongst the most commonly used ULMs. However, there has not been much research evidencing the comparison of these agents. In order to address this particular issue, researchers conducted a systematic review and meta-analysis to recover data from the trials on comparison of ULMs in the treatment of gout.
Efficacy outcomes considered in meta-analysis included achievement of therapeutic target of sUA level (<6 mg/dl) by 1% of patients and % reduction in sUA concentration at the end of study compared to sUA values before intervention. Safety analysis was also conducted.
Overall, 16 papers were found to be concerned with febuxostat, 15 with allopurinol, 4 with benzbromarone and none with probenecid. The finding from the papers showed that 70.7% of patients reached the target of sUA with febuxostat therapy and the reduction in sUA was 45.3%. With allopurinol the results were 44.4% and 33.8%, respectively. With benzbromarone, it was difficult to retrieve conclusive findings due to low level of patients. Safety analysis also favored febuxostat over allopurinol (OR 0.85; 95% CI: 0.75-0.97).
Therefore, findings from this study suggest febuxostat, an important drug for the treatment of hyperuricaemia and gout. It is considered to be the first line treatment for gout due to its established efficacy and safety, acknowledged in maximum number of clinical studies.