Febuxostat For Gout: A Systemetic Review

Objective To systemically review and investigate the eficacy and safety of febuxostat for gout.Methods To search PubMed,EMBASE,CENTRAL,CBM,CNKI,VIP,The search was concluded in December,2009. The quality of randomized controlled trials assessing febuxostat for gout was evaluated.And the extracted data were calculated by the Cochrane Collaboration's software RevMan 5.0.Result Four trials involving 3073 participants with hyperuricemia and gout. There were 2647 participants in febuxostat groups and 426 participants in control groups.The results of Meta-analysis showed: febuxostat was more effective than placebo in reducing serum urate,the effect sizes was [P<0.00001,RR=112.14,95%CI(35.03,359.03)],serum urate improvement compared with baseline[P<0.00001,SMD=-48.96,95%CI(-56.80,-41.11)]. When gout flare prophylaxis was provided, greater proportions of subjects receiving febuxostat required treatment for gout flares compared with those receiving placebo[P< 0.00001, RR=1.74, 95%CI (1.41,2.14)]. After the prophylaxis period , there were no statistically significant differences in the proportion of subjects requiring treatment for gout flares observed between the febuxostat groups and placebo groups[P=0.52 , RR=1.04 , 95%CI(0.92 , 1.18)]. Compared with allopurinol, febuxostat was more effective than allopurinol in reducing serum urate [P<0.00001,RR=2.55,95%CI(2.32,2.80)], serum urate improvement compared with baseline [P<0.00001,SMD=-19.00,95%CI(-23.71,-14.30)]. When gout flare prophylaxis was provided, greater proportions of subjects receiving febuxostat required treatment for gout flares compared with those receiving allopurinol[P=0.0010,RR=1.44,95%CI(1.16,1.78)]. After the prophylaxis period,there were no statistically significant differences in the proportion of subjects requiring treatment for gout flares observed between the febuxostat groups and allopurinol groups[P=0.60,RR=1.02,95%CI(0.95,1.10)]. No significant differences in the number and size of tophi were observed between treatment groups. Among subjects with tophi, longterm maintenance of the goal serum urate range was accompanied by reductions in the areas of index tophi and and in the number of tophi and by the proportion of index tophi undergoing complete resolution. Most adverse events were mild to moderate in severity. The incidence of adverse events was similar in each group. The most frequently reported adverse events were diarrhea, headache, nausea, back pain, dizziness, skin rash, abnormal liver function and so on. The incidence of serious adverse events was numerically higher with febuxostat than with placebo, but the difference between treatments was not statistically significant.Conclusions Current evidence demonstrates that febuxostat is efficacy in lowering serum urate. Adverse reactions of its is relatively slighter.