1. OBJECTIVES and METHODOLOGY.
SINGLE CENTRE EXPERIENCE WITH FEBUXOSTAT FOR CHRONIC GOUT
Othman AZ , Shahril NS , Mohd Isa L , Hussein H
Putrajaya Hospital, Putrajaya, MALAYSIA
INTRODUCTION .
Allopurinol is the mainstay therapy for treatment of chronic gouty arthritis. In patients with allopurinol hypersensitivity syndrome (AHS) and allopurinol failure , Febuxostat , a non-purine selective xanthine oxidase inhibitor is used as an alternative treatment. In AHS, the probability of developing cross-related intolerance to Febuxostat is low. In our hospital the use of Febuxostat is limited due its high cost.
OBJECTIVES and METHODOLOGY
Objective
To describe our experience with Febuxostat in the treatment of chronic gout.
Methodology
This was a retrospective study looking at the electronic medical record of our hospital database. 203 gout patients were traced and those who had received febuxostat were selected. Data on demographic, clinical presentation, laboratory features and progress of these selected patients were reviewed.
RESULTS
CONCLUSION
Only 5 (4 males, 1 female) out of 203 gout patients had received Febuxostat since The profile of these 5 patients are summarised in Table 1 .
Febuxostat had shown to be effective in achieving target SUA in our chronic topacheous gout patients. Limitations include non compliance and drug intolerance. Two out of our 5 patients developed generalized rashes. Factors leading to Febuxostat intolerance on the background of AHS needs to be further studied.
Table 1
PROFILE
DESCRIPTION
Clinical Presentation
Polyarticular chronic tophaceous gout (n=5)
Urolithiasis (n=5)
Low creatinine clearance (n=5)
Indication
AHS (n=4)
Stage 4 Chronic kidney disease and failure to reach target serum uric acid (SUA) level < 360µmol/L.(n=1)
Symptoms of AHS
Steven-Johnson Syndrome (n=1)
Toxic Epidermal Necrolysis (n=1)
Generalised Exfoliative Dermatitis (n=2)
Outcome of treatment
Achieved target SUA after 4 months treatment at 40mg daily (n=1)
Achieved target SUA after 8 months treatment at 80mg daily (n=1)
Failure to reach SUA due to non-compliance (n=1)
Discontinue treatment due to generalized eczematous rashes (n=2)
Side effects
Generalized eczematous rashes (n=2)
Hepatic abnormalities (n=0)
REFERENCES
Guidelines Committee. Clinical Practice Guidelines: Management of Gout.
Putrajaya: Ministry of Health, Malaysian Society of Rheumatology,
Academy of Medicine, Malaysia; 2008
Khanna D, Fitzgerald J, Khanna P, et al American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res 2012;64(10):
Becker M, Schumacher J, Wortmann R, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005;353:
Chohan S. Safety and efficacy of Febuxostat treatment in subjects with gout and severe Allopurinol adverse reactions. J Rheumatol 2011;38:
A.M. Abeles. Febuxostat hypersensitivity. J Rheum 2012;39(3):659 ..
References