- Like patients with diabetes, patients with gout represent, in absolute terms, a large group of patients at clearly increased cardiovascular risk. It is clinically relevant to know the cardiovascular safety of the drugs that they might have to use for the rest of their lives.
- Allopurinol and febuxostat are both indicated for chronic use by patients with gout who experience an unacceptable burden of symptoms like painful gout attacks or subcutaneous nodules formed by deposition of uric acid crystals (tophi).
- Recent research has found that the cardiovascular safety of febuxostat appears to be equivalent to that of allopurinol. The study did, however, have various limitations.
- The elevated risk of death, including mortality due to cardiovascular disorders, which had in fact already been suspected, is an additional argument for opting for allopurinol rather than for febuxostat.
- In all, allopurinol, a drug with which decades of experience have been gained, remains the drug of first choice for lowering uric acid levels. The costly drug febuxostat, which has only been registered in the Netherlands since 2014, should for now only play a limited role, in case of failure or adverse side effects of allopurinol.
- Abhishek A. Managing Gout Flares in the Elderly: Practical Considerations. Drugs Aging 2017; 34(12): 873-880.
- Janssens HJ. Behandeling van jicht. Gebu 2010;44(10):109-115.
- Van der Helm-Van Mil AHM, Janssens HJEM, Lopuhaä DE, van Peet PG, Schaafstra A, Shackleton DP, et al. NHG-Standaard Artritis 2017. Via: www.nhg.org.
- Qaseem A, Harris RP, Forciea MA. Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166(1): 58-68.
- Janssens HJ. Controverse over progylactische urinezuurverlaging bij jicht. Gebu 2018;52(1-2):9-10.
- Janssens HJ, Arts PG, Schalk BW, Biermans MC. Gout and rheumatoid arthritis, both to keep in mind in cardiovascular risk management: A primary care retrospective cohort study. Joint Bone Spine 2017; 84(1): 59-64.
- Clarson LE, Hider SL, Belcher J, Heneghan C, Roddy E, Mallen CD. Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK Clinical Practice Research Datalink. AnnRheumatic Dis. 2015;74(4):642-7.
- Faruque LI, Ehteshami-Afshar A, Wiebe N, Tjosvold L, Homik J, Tonelli M. A
systematic review and meta-analysis on the safety and efficacy of febuxostat
versus allopurinol in chronic gout. Semin Arthritis Rheum 2013;43(3):367-75.
- GIPdatabank. College voor Zorgverzekeringen. Via: www.gipdatabank.nl.
- FDA Guidance for Industry - Diabetes Mellitus - Evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes. December 2008. Via: https://www.fda.gov/downloads/Drugs/Guidances/ucm071627.pdf.
- White WB, Saag KG, Becker MA, Borer JS, Gorelick PB, Whelton A, et al. Cardiovascular safety of febuxostat or allopurinol in patients with gout. N Engl J Med 2018; 378(13): 1200-1210.
- dr O.M. Dekkers. Het non-inferioriteitsonderzoek. Gebu 2015;49(3):27-34.
- Anoniem. Keuze en interpretatie van uitkomstmaten in gerandomiseerd onderzoek. Gebu 2014;48(7):71-78.
- Informatorium Medicamentorum. Den Haag: KNMP, 2018. Via: KNMP Kennisbank online.
The literature refers to the Dutch text