The place of febuxostat in the treatment of gout

The curation of patients with gout involves the mandatory prescription of pathogenetic therapy with urate-lowering drugs, among which xanthine oxidase inhibitors, such as allopurinol and febuxostat, are most widely used. According to various national and international guidelines, allopurinol is the first line drug for gout. However, there is a large cohort of patients, in whom the use of febuxostat is not only justified, but is also preferable. First of all, these are patients who are intolerant to allopurinol and at a high risk of severe skin reactions. There is a high risk of mortality and a low probability of achieving the target uric acid level when allopurinol is prescribed for patients with diminished renal function. Taking into account the fact that febuxostat has a pronounced nephroprotective effect, prescribing the drug in these patients will be a more effective way to achieve normouricemia. At the same time, the presence of cardiovascular diseases, although this requires additional caution when choosing therapy, should not be a reason for refusal to take febuxostat, since the results of many studies not only have failed to confirm a higher risk for cardiovascular events during therapy with this drug, but also have shown that it has cardioprotective properties.