title: Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: a twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout.
abstract: OBJECTIVE
  Gout affects approximately 1-2% of the American population. Current options for treating hyperuricemia in chronic gout are limited. The purpose of this study was to assess the safety and efficacy of febuxostat, a nonpurine selective inhibitor of xanthine oxidase, in establishing normal serum urate (sUA) concentrations in gout patients with hyperuricemia (>or=8.0 mg/dl).
  
  
  METHODS
  We conducted a phase II, randomized, double-blind, placebo-controlled trial in 153 patients (ages 23-80 years). Subjects received febuxostat (40 mg, 80 mg, 120 mg) or placebo once daily for 28 days and colchicine prophylaxis for 14 days prior to and 14 days after randomization. The primary end point was the proportion of subjects with sUA levels <6.0 mg/dl on day 28.
  
  
  RESULTS
  Greater proportions of febuxostat-treated patients than placebo-treated patients achieved an sUA level <6.0 mg/dl at each visit (P < 0.001 for each comparison). The targeted sUA level was attained on day 28 in 0% of those taking placebo and in 56% of those taking 40 mg, 76% taking 80 mg, and 94% taking 120 mg of febuxostat. The mean sUA reduction from baseline to day 28 was 2% in the placebo group and 37% in the 40-mg, 44% in the 80-mg, and 59% in the 120-mg febuxostat groups. Gout flares occurred with similar frequency in the placebo (37%) and 40-mg febuxostat (35%) groups and with increased frequency in the higher dosage febuxostat groups (43% taking 80 mg; 55% taking 120 mg). During colchicine prophylaxis, gout flares occurred less frequently (8-13%). Incidences of treatment-related adverse events were similar in the febuxostat and placebo groups.
  
  
  CONCLUSIONS
  Treatment with febuxostat resulted in a significant reduction of sUA levels at all dosages. Febuxostat therapy was safe and well tolerated.
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA. mbecker@medicine.bsd.uchicago.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Becker
authors.forename: H Ralph
authors.initials: HR
authors.lastname: Schumacher
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wortmann
authors.forename: Patricia A
authors.initials: PA
authors.lastname: MacDonald
authors.forename: William A
authors.initials: WA
authors.lastname: Palo
authors.forename: Denise
authors.initials: D
authors.lastname: Eustace
authors.forename: Laurent
authors.initials: L
authors.lastname: Vernillet
authors.forename: Nancy
authors.initials: N
authors.lastname: Joseph-Ridge
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D000069465:Febuxostat; D005260:Female; D006073:Gout / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013844:Thiazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors*
chemical_list: D004791:Enzyme Inhibitors; D013844:Thiazoles; D000069465:Febuxostat; D014527:Uric Acid; D014969:Xanthine Oxidase