Starting Febuxostat During an Acute Gout Flare Save

A randomized controlled trial in gout patients has shown that starting febuxostat during an acute gout flare was without ill-effects and did not prolong the gouty attack.

A multicenter, randomized, placebo-controlled, trial enrolled 140 gout patients with an acute gout flares within 72 hrs and randomized (1:1) them to either placebo or febuxostat (40 mg/day). Acute gout was also managed with diclofenac (150 mg/day) for 7 days and then open-labelled on the eighth day.

For gout attacks the mean time to resolution was 6.0 days for placebo and 6.5 days for febuxostat group (P = 0.578).

Gout resolution within 7 days was 84% for the placebo group and 77% for the febuxostat group (P = 0.284).  Otherwise there were were no significant differences in joint pain, swelling, tenderness and erythema scores at days 1, 3, 5 and 7.

The only significiant difference was the mean serum uric acid levels were lower on day 7 in the febuxostat group (507 PBO and 362 μmol/febuxostat; P = 0.000). 

Starting febuxostat during an acute gout attack (especially in those with recurrent gout) appears to be adviseable and does not prolong the duration of acute flares.