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Febuxostat delivers superior uric acid control with similar safety compared to allopurinol in gout management.
A meta-analysis by Feng Zhang et al. has reaffirmed febuxostat’s advantage in lowering serum uric acid (SUA) levels compared with allopurinol among patients with gout, while maintaining an acceptable safety profile.
The study aimed to compare the treatment efficacy and safety of various doses of febuxostat and allopurinol in gout management, focusing on SUA reduction, frequency of gout flares, and adverse events. Researchers systematically reviewed randomized controlled trials from multiple electronic databases, incorporating 16 studies involving 19,683 gout patients.
The analysis evaluated the proportion of patients attaining SUA ≤6.0 mg/dL, mean SUA changes, gout attack incidence, and overall safety outcomes. Pooled effect sizes were calculated using random-effects models, with standardized mean differences (SMD), relative risk (RR), risk difference (RD), and 95% confidence interval (CI).
Key findings
Efficacy
Febuxostat illustrated markedly higher rates of uric acid target achievement when compared to allopurinol, especially at 40–80 mg/day (RR = 1.14) and >80 mg/day (RR = 2.75). It also led to a more pronounced reduction in overall SUA levels (SMD = −0.70).
Gout Flares
No prominent difference was noted in gout attack risk between febuxostat and allopurinol (RR = 1.13).
Safety
The risk of any-grade adverse events was slightly lower in the febuxostat group (RR = 0.95). However, no vital differences were noted in treatment-related (RR = 0.99) or serious adverse events (RD = −0.01).
The findings highlight febuxostat’s superior urate-lowering capability compared with allopurinol, without escalating the risk of gout flares or serious adverse events. The analysis supports febuxostat as an effective and generally safe therapeutic option for gout. Nonetheless, researchers emphasize the need for more high-quality, long-term studies to validate these results and further assess cardiovascular and renal outcomes.
Joint Diseases and Related Surgery
The efficacy and safety of different doses of febuxostat and allopurinol: A meta-analysis
Feng Zhang et al.
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