• Naoyuki Kamatani, Kamatani Naoyuki, Shin Fujimori, Fujimori Shin, Toshikazu Hada, Hada Toshikazu, Tatsuo Hosoya, Hosoya Tatsuo, Kenjiro Kohri, Kohri Kenjiro, Toshitaka Nakamura, Nakamura Toshitaka, Takanori Ueda, Ueda Takanori, Tetsuya Yamamoto, Yamamoto Tetsuya, Hisashi Yamanaka, Yamanaka Hisashi, Yuji Matsuzawa, and Matsuzawa Yuji.
• Institute of Rheumatology, Tokyo Women's Medical University, Teikyo University, Tokyo, Japan. kamatani@msb.biglobe.ne.jp
• J Clin Rheumatol. 2011 Jun 1; 17 (4 Suppl 2): S35-43.

BackgroundAllopurinol has been widely used for the treatment of hyperuricemia, however, it may be associated with various adverse effects. Febuxostat has been identified as a potentially safe and efficacious alternative.ObjectivesA multicenter study with randomized, placebo-controlled, double-blind, parallel, intergroup comparison was carried out to evaluate the dose-response relationship, efficacy, and safety of febuxostat in 202 patients with hyperuricemia (including patients with gout) in Japan.MethodsThe subjects were treated with febuxostat at fixed maintenance doses (20-80 mg/d) or a placebo for 16 weeks. The percentage of patients achieving serum uric acid levels 6.0 mg/dL or less and the percent change in serum uric acid levels after 16 weeks of treatment were evaluated.ResultsThe percentage of patients achieving serum uric acid levels 6.0 mg/dL or less at 16 weeks was 87.8% in the 80-mg/d dose group, 83.3% in the 60-mg/d group, 82.9% in the 40-mg/d group, 46.5% in the 20-mg/d group, and 2.6% in the placebo group (P < 0.001, Mantel-Haenszel test). A statistically significant dose-response relationship was found. The percent change in serum uric acid levels after 16 weeks of treatment differed significantly between each febuxostat dose group and the placebo group and increased in a dose-dependent manner above 40 mg/d. No deaths, events posing a clinical problem, or serious adverse reactions attributable to febuxostat were noted. Similar results were obtained regardless of gout history.ConclusionsFebuxostat can safely reduce serum uric acid levels to 6.0 mg/dL or less in 80% or more of patients with hyperuricemia (including gout) at doses of 40 mg/d or higher.

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