title: Febuxostat: drug review and update.
abstract: BACKGROUND
  Gouty arthritis and hyperuricemia have ailed humans for centuries. Recent advances in understanding of the mechanism(s) of their development have changed our perception of the disease process. Despite these gains, the treatment options available are limited. The FDA approval of febuxostat for the treatment of hyperuricemia in gout has been a significant step forward. Since its approval in 2009, febuxostat has proven to be safe and efficacious although concerns remain regarding its long-term effects and superiority to other uricosuric agents, such as allopurinol.
  
  
  METHODS
  A comprehensive literature review of PubMed and Ovid examining clinical trials and post-marketing studies yielded congruent findings on efficacy and safety in elderly populations and those with mild-to-moderate renal/hepatic impairment. A lack of literature and clinical studies was found with regard to comparison of febuxostat to FDA-approved high-dose allopurinol (> 300 mg), the safety of febuxostat in the treatment of severe renal/hepatic impairment and the benefit in the treatment of secondary cases of hyperuricemia.
  
  
  CONCLUSIONS
  Febuxostat is effective in the treatment of mild-to-moderate renal/hepatic impairment with dramatic effects on the serum urate level. It can be used safely in patients with hypersensitivity reactions to allopurinol. Further research is needed to determine the long-term benefits and risks.
authors.affiliation: Louisiana State University - School of Medicine, Section of Rheumatology , New Orleans, LA , USA hgrew1@lsuhsc.edu.
authors.forename: Harmanjot K
authors.initials: HK
authors.lastname: Grewal
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Martinez
authors.forename: Luis R
authors.initials: LR
authors.lastname: Espinoza
mesh_terms: D000818:Animals; D015210:Arthritis, Gouty / Q000188:drug therapy* / Q000201:enzymology / Q000378:metabolism; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000069465:Febuxostat; D006074:Gout Suppressants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D048550:Hepatic Insufficiency / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy* / Q000201:enzymology / Q000378:metabolism; D008099:Liver / Q000187:drug effects / Q000503:physiopathology; D013844:Thiazoles / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D004791:Enzyme Inhibitors; D006074:Gout Suppressants; D013844:Thiazoles; D000069465:Febuxostat; D014969:Xanthine Oxidase