A new interpretation of the cardiovascular safety of febuxostat

Febuxostat, an oral non-purine selective xanthine oxidase inhibitor, was approved firstly in Europe in 2008 for the treatment of chronic hyperuricemia in gout patients, and then in 2009 for the treatment of gout by the US FDA. In 2013, it was found by researchers that there was a possible correlation between febuxostat and cardiovascular thromboembolism events. In 2017, the US FDA issued a safety warning for febuxostat. In March 2018, the results of an eight-year study on Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Comorbidities(CARES)was officially published. The study showed that febuxostat increased all-cause mortality and cardiovascular mortality in gout patients with cardiovascular disease. However, in subsequent clinical studies related to febuxostat, it was concluded that febuxostat did not increase cardiovascular risk and mortality, and could have cardio-cerebrovascular and renal protective effects in patients with hyperuricemia. Currently, the pros and cons of febuxostat on cardiovascular safety are not clear in general studies, and more clinical studies are needed, especially in the Chinese population. Thus, before treatment with febuxostat, it is necessary to carefully inquire whether the patient has a history of cardiovascular diseases, and whether there is a combination use of NSAID, antiplatelet drugs and so on. Febuxostat should be used only after a full consideration of the possible risks. Key words: Febuxostat; gout; hyperuricemia; Xanthine oxidase inhibitors; cardiovascular events