Stepwise dose increase of Febuxostat is comparable with Colchicine prophylaxis for the prevention of gout flares during the initial phase of urate-lowering therapy

During the initial stages of urate-lowering therapy, gout flares frequently develop. To treat this stepwise dose increase and colchicine prophylaxis are the two potential strategies. However, none of the authors conducted any prospective clinical to compare the efficacy of these two strategies. Therefore, the present study suggested that stepwise dose increase of febuxostat and low-dose colchicine prophylaxis efficiently reduced gout flares in comparison with fixed-dose febuxostat alone.

This study aimed to assess whether febuxostat with stepwise dose elevation is as beneficial as colchicine prophylaxis for managing gout flares at the starting of urate-lowering therapy than febuxostat with no dose titration among patients with gout.  

The selected patients were divided into three categories; group A, B and C. Group A received 10 to 40 mg/day febuxostat stepwise dose increase. Group B obtained 40 mg/ day fixed-dose febuxostat along with 0.5 mg/day colchicine. Group C received fixed-dose febuxostat 40 mg/day only. All groups went through a 12 weeks observation. Non-steroidal anti-inflammatory drug utilize for gout symptoms used to define the gout flares.

A total of 241 patients treated out of 255 patients. Out of 241 patients, 20 patients from group A, 18 from group B and 18 from group C found to have gout flares. Group C exhibited a higher incidence of flares than group B and A. However, the difference was not significant following the correction for multiple comparisons. The group A and B exhibited no notable difference between the gout flares incidences.

The study findings proposed that the stepwise dose increase of febuxostat along with low-dose colchicine prophylaxis is very effective to lessen gout flares than the alone fixed-dose febuxostat.