Comparison of Gout Flares With the Initiation of Treat‐to‐Target Allopurinol and Febuxostat: A Post‐Hoc Analysis of a Randomized Multicenter Trial
Primary result · Gout flareResult — go to the resultHazard ratio 1.17Authors' conclusion
These results demonstrate that gout flare risk during the initiation and titration of allopurinol is similar to febuxostat when these agents are administered according to a treat-to-target strategy using gradual ULT-dose titration and best practice gout flare prophylaxis.
Study context
- Population
- Gout patients initiating urate-lowering therapy (ULT); predominantly male (98.4%), mean age 62.1 years, mean baseline serum urate (sUA) 8.5 mg/dl; all received anti-inflammatory prophylaxis (90% colchicine)
- Participants
- 940 patients
- Comparison
- Febuxostat vs allopurinol, treat-to-target ULT initiation and titration with anti-inflammatory prophylaxis
- Primary endpoint
- Occurrence of gout flares during ULT initiation and titration
- Follow-up
- Weeks 0 to 24
Methodological details72-week, double-blind, placebo-controlled, noninferiority, multicenter, multivariable Cox proportional hazards regression, Flares assessed at regular intervals through structured participant interviews
- 72-week
- Double-blind
- Placebo-controlled
- Noninferiority
- Multicenter
- Multivariable Cox proportional hazards regression
- Flares assessed at regular intervals through structured participant interviews
Primary result
Gout flare
Hazard ratio
1.17
As reported in the abstract
Further findings
| Outcome | HR |
|---|---|
| Gout flare by ULT-dose escalation · weeks 0 to 24ULT-dose escalation vs No escalation · not significant | 1.18 |
Gout flare by ULT-dose escalation · weeks 0 to 24
- No evidence of ULT-dose escalation interaction
Other predictors of flare · weeks 0 to 24
- No significant association of prophylaxis type or individual comorbidity with flare
- Younger age, higher baseline sUA and absence of tophi independently associated with flare risk
Original publication
Comparison of Gout Flares With the Initiation of Treat‐to‐Target Allopurinol and Febuxostat: A Post‐Hoc Analysis of a Randomized Multicenter Trial. Arthritis Rheumatol. Published 15 July 2024. doi:10.
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