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Lee and a group of Korean investigators have analyzed the comparative safety of allopurinol and febuxostat in a small cohort of gout patients with fatty liver disease (FLD) and found febuxostat had a lower risk for hepatotoxicity (defined as AST or ALT at least 3× the upper limit of normal) compared to allopurinol.
They identified 134 (relatively well matched) patients who had gout and FLD, 32 (23.9%) received febuxostat and 102 (76.1%) received allopurinol.
Hepatotoxicity was significantly lower in those on febuxostat (9.4%) compared to patients on allopurinol (35.3%, p = 0.005).
Comparatively, diabetes (HR 3.5) and colchicine use (HR 11.5) were associated a significantly higher risk of hepatotoxicity (p < 0.001), while febuxostat use was associated with a lower risk of hepatotoxicity (HR 0.282, 95% CI 0.086-0.926, p = 0.037).