Febuxostat is authorised for the treatment of chronic hyperuricaemia in conditions where urate deposition has already occurred.
Febuxostat is not better than allopurinol at reducing the number of patients with gout attacks in weeks 9-52. During the first 8 weeks of treatment, more attacks were seen among patients treated with febuxostat compared with patients treated with allopurinol. The clinically most relevant endpoint, the total frequency of attacks, was not estimated.
The serum urate treatment target is reached significantly more frequently among patients treated with febuxostat than among patients treated with allopurinol. This may give fewer attacks in the long term if patients continue the treatment, however, the majority of patients do not.
Febuxostat has only been tested against allopurinol in daily doses of 300 mg, which does not reflect clinical practice to uptitrate, often to doses greater than this. Therefore, it cannot be determined whether the drugs are equieffective in relation to lowering the serum urate level.
Allopurinol is far less expensive than febuxostat. Febuxostat has not been tested against probenecide, and consequently its place in the treatment hierarchy cannot be determined.
It is IRF's overall assessment that allopurinol remains the first choice of treatment for gout.
Febuxostat was marketed on 10 June 2013 and single reimbursement may be applied for.