title: Risk of cutaneous adverse events with febuxostat treatment in patients with skin reaction to allopurinol. A retrospective, hospital-based study of 101 patients with consecutive allopurinol and febuxostat treatment.
abstract: OBJECTIVE
  To investigate the cutaneous tolerance of febuxostat in gouty patients with skin intolerance to allopurinol.
  
  
  METHODS
  We identified all gouty patients who had sequentially received allopurinol and febuxostat in the rheumatology departments of 4 university hospitals in France and collected data from hospital files using a predefined protocol. Patients who had not visited the prescribing physician during at least 2 months after febuxostat prescription were excluded. The odds ratio (OR) for skin reaction to febuxostat in patients with a cutaneous reaction to allopurinol versus no reaction was calculated. For estimating the 95% confidence interval (95% CI), we used the usual Wald method and a bootstrap method.
  
  
  RESULTS
  In total, 113 gouty patients had sequentially received allopurinol and febuxostat; 12 did not visit the prescribing physician after febuxostat prescription and were excluded. Among 101 patients (86 males, mean age 61±13.9 years), 2/22 (9.1%) with a history of cutaneous reactions to allopurinol showed skin reactions to febuxostat. Two of 79 patients (2.5%) without a skin reaction to allopurinol showed skin intolerance to febuxostat. The ORs were not statistically significant with the usual Wald method (3.85 [95% CI 0.51-29.04]) or bootstrap method (3.86 [95% CI 0.80-18.74]).
  
  
  CONCLUSIONS
  The risk of skin reaction with febuxostat seems moderately increased in patients with a history of cutaneous adverse events with allopurinol. This moderate increase does not support the cross-reactivity of the two drugs.
authors.affiliation: Rheumatology department, Viggo Petersen center, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Inserm, UMR 1132, 75010 Paris, France. Electronic address: thomas.bardin@lrb.aphp.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bardin
authors.affiliation: Rheumatology department, University of Rennes 1, hôpital Sud, CHU de Rennes, Rennes, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Chalès
authors.affiliation: Rheumatology department, University Hospital of Lille, and University of Lille 2, 59000 Lille, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Pascart
authors.affiliation: Rheumatology department, University Hospital of Lille, and University of Lille 2, 59000 Lille, France.
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.affiliation: Rheumatology department, Viggo Petersen center, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Inserm, UMR 1132, 75010 Paris, France.
authors.forename: Hang
authors.initials: H
authors.lastname: Korng Ea
authors.affiliation: Université Paris-Est Créteil, 94000 Créteil, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Roujeau
authors.affiliation: Orgamétrie biostatistiques, 59512 Roubaix, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Delayen
authors.affiliation: Orgamétrie biostatistiques, 59512 Roubaix, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Clerson
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000009:adverse effects* / Q000627:therapeutic use; D003875:Drug Eruptions / Q000209:etiology*; D000069465:Febuxostat / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006073:Gout / Q000188:drug therapy*; D006074:Gout Suppressants / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006074:Gout Suppressants; D000069465:Febuxostat; D000493:Allopurinol
keywords: Allopurinol; Cross-reactivity; Febuxostat; Gout; Severe cutaneous adverse reaction (SCAR); Skin reaction