Febuxostat prevented early gout flares

The urate-lowering therapy febuxostat reduced the number of disease flares that the people with early gout experienced, relative to placebo, in a double-blind study.

Febuxostat (Uloric) produced a 12.1 percent reduction in the overall percentage of patients who experienced at least one gout flare, in comparison with placebo (29.3 percent vs. 41.4 percent; P<.05).

Treatment with febuxostat also significantly improved control of serum uric acid, compared with the placebo-treated patients (64.3 percent vs. 5.7 percent;P<.001), as well as synovitis as measured via the rheumatoid arthritis magnetic  resonance imaging score (RAMRIS) (-0.43 vs. -0.07; P<.001).

Current clinical practice guidelines do not recommend routine use of urate-lowering therapy for people after their first gout flare, said in a press statement. Such therapy is usually used when patients experience frequent flares, typically at least two in the preceding year.

This study indicates that even for people who have only had one or two prior gout flares, urate-lowering therapy to reduce serum urate below 6 mg/dl may have benefit in reducing future flares.

The researchers found no noticeable differences between the study groups in terms of radiologic joint erosion.

This was a phase 2 study conducted in 56 centers in the United States that screened 798 subjects and enrolled 314 adults with early gout. For inclusion, patients had to have hyperuricemia, defined as a serum uric acid level of 7.0 mg/dl, or higher, and they had to have experienced no more than two gout flares in the past year.

Patients were randomized to once-daily treatment with febuxostat of placebo, with those randomized to the active treatment started at a dose of 40mg, which could be increased to 80 mg after 2 weeks if serum uric acid levels remained high, at 6.0 mg/dl or above.