Febuxostat is a fairly new anti-gout treatment, meant to lower uric acid levels in the blood. It is thought to replace allopurinol, the current drug of choice for gout sufferers. Febuxostat shows improved lower levels of uric acid, as well as milder side effects. However, it is still unknown if Febuxostat will have any effect in stopping gouty attacks, or if it is cheaper to use in the long run.
The Connection of Uric Acid and Gout
Gout is an articular joint condition caused by crystal deposits within the joint and surrounding connective tissues. Those crystal deposits—termed as tophi—cause inflammation to the joint, resulting in gouty arthritis attacks with red, swollen, and very painful joint, usually in the big toe, fingers, elbows, or knees. The crystal deposits associated with gout are from urate crystals, which form from excess uric acid in the bloodstream. If there are low to moderate levels of uric acid in the blood, no urate crystals will form, and no gout will take place.
However, uric acid forms when the body breaks down purine, which is an enzyme found in all living forms, such as animals and plants. This means that every food item that people eat contains purine—though some foods contain higher concentrates of purine than others. Meats, seafood and shellfish, innards, beans, and alcohol, in particular, contain some of the highest levels of purine. As such, excessive and habitual consumption of these foods and without the proper elimination of uric acid could result to gout.
How Febuxostat and Allopurinol Work
Aside from administering analgesics or painkillers during the excruciating attacks of gouty arthritis, doctors will also include medication to lower the high levels of uric acid in the blood, or hyperuricemia, as it is termed in the medical world. Ever since, allopurinol has been the drug of choice for gout; it works by inhibiting the production of uric acid from the breakdown of purine. If there is less byproducts of purine, there will be a lower uric acid level in the blood.
Allopurinol works, and it has continued to work through the years. In fact, it is still the drug of choice for gout in many countries. Recently, however, a new gout treatment has been repeatedly tested to see if it would be a better choice over allopurinol. This fairly new medication is called febuxostat.
Febuxostat, more commonly known as Uloric in the US, also lowers uric acid by inhibiting the production of it by hindering the chemical process that results in the said byproduct of purine. In a sense, both febuxostat and allopurinol work in lowering the uric acid level in the blood; both work in similar fashions, though with a slight difference in their mode of action.
Benefits of Febuxostat
According to research and clinical trials, febuxostat has proven to be more effective in reducing uric acid levels than allopurinol. The tests have shown that lower doses of febuxostat resulted to the same or even greater effect than a much-higher dose of allopurinol in gout patients with normal kidney function. In this regard, febuxostat exceeds allopurinol without question.
Another benefit of the drug is that it has also shown an improved efficacy to those who are intolerant to allopurinol. There are people who cannot take allopurinol, with some even exhibiting hypersensitivity or severe allergic reactions to allopurinol, with even fatal adverse effects. With the emergence of this new medication, however, those people who are intolerant to allopurinol will now have their own medication to help them lower their blood uric acid levels.
One of the benefits of allopurinol when it was introduced during its time was that it can be used even in patients with poor kidney function. As uric acid is excreted along with urine, it should be logical that an increase in urination will also increase the excretion of excess uric acid. However, there are patients with impaired or damaged kidneys, resulting to poor filtering of wastes. Causing the body to increase its production of urine when the kidneys are already damaged will cause more harm.
Allopurinol was ideal at the time because it is not a uricosuric drug, meaning it is not a drug that promotes or increases the production of urine. This means that allopurinol can be administered even to gout sufferers with poor renal function.
The good news is that febuxostat is non-uricosuric as well, meaning it can be administered to those with allopurinol intolerance and to those with poor kidney functions as well.
Comparison of Side Effects
The efficacy of a drug is a major component, but so are its side effects. A drug might be extremely effective, but if it will leave the patient with long term side effects that are debilitating or even fatal, it will not be of much use.
Both febuxostat and allopurinol have side effects—some are more adverse than others. However, febuxostat side effects are generally milder in comparison to allopurinol.
To give a better view of the comparison, here are the possible side effects of allopurinol:
- Hypersensitivity syndrome—potentially fatal
- Skin rash
- Worsened kidney function
- Toxic epidermal necrolysis
- Steven-Johnson syndrome
- Aplastic anemia
- Interstitial nephritis
- Peripheral neuritis, although rare
- Possible congenital defects when taken during pregnancy
Here are the febuxostat side effects that could occur:
- Skin rash
- Joint pain
- An increase in the serum enzyme of the liver
Judging from this comparison, it appears that febuxostat has fewer side effects than allopurinol. However, it is far from being a perfect gout medication as well.
Particularly, the medication has not been proven to provide any relief or any positive effect on patients with an ongoing attack of gouty arthritis. It has also not shown any improvements in terms of tophi formation and elimination, meaning as of now, febuxostat will be better as a preventive medication of gout’s fourth stage, or the chronic tophaceous gout stage. In this regard, it is the same as allopurinol, in that both are better as preventive medications rather than curative medications. It is now a big question whether the long-term use of febuxostat will be more cost-efficient than the long-term use of allopurinol. Currently, there have been no results to answer that question.
Is febuxostat better than allopurinol? It is hard to say. As a preventive drug, both are equally effective in lowering uric acid levels, though the former has proven to be more effective. Febuxostat has also shown to produce fewer and milder side effects than allopurinol, which is a great alternative for those with hypersensitivity issues. However, it is still unclear whether its prolonged use will still be as cost-effective as allopurinol, the current drug of choice. In the end, these medications alone will not banish gout for good—it must be coupled with a healthier lifestyle and with healthier food choices.