Treatment of Gout—A new Approach

Abstract

Since a long time back allopurinol has been constantly use to subsidize uric acid level in blood by competitive and suicidal inhibition of xanthine oxidase. Barring a few side few tolerable effects there was never felt any emergency for invention of an alternative. But a dire research was going on to bring into light an alternative which is better than allopurinol in some aspects. Now a non-purine xanthine oxidase Febuxostat is a new non-purine xanthine oxidase inhibitor that is more potent than allopurinol 300 mg daily. Febuxostat was more effective than allopurinol in the subset with impaired renal function. Long-term extension studies at different levels confirmed the efficacy and tolerability of Febuxostat. In patients who achieved the Serum uric acid level of 6 mg/dl (360 μmol/l), the incidence of gout flares fell steadily and tophi resolved in many patients. The incidence of adverse events such as dizziness, diarrhoea, headache and nausea with Febuxostat was similar to allopurinol. The incidence of cardiovascular side-effects was numerically higher with Febuxostat than with allopurinol, but this was not statistically significant. Co-administration of Febuxostat with AZA or 6mercaptopurine is not recommended. Prophylaxis (colchicines and/or NSAIDs) against acute attacks should be used for at least the first 6 months, since early mobilization flares were observed in the clinical trials. In conclusion, Febuxostat is more effective than allopurinol 300 mg daily in reducing uric acid level 6 mg/dl (360 μmol/l), the target recommended long term option for treatment of gout.