To the Editor: Thank you for the thorough review of gout and chronic kidney disease in the December 2010 issue of Cleveland Clinic Journal of Medicine.
Table 2 displays results from the Febuxostat Versus Allopurinol Controlled Trial (FACT), in which we see that 76% of patients treated with febuxostat 80 mg per day achieved a serum uric acid level of less than 6 mg/dL at week 28. With a dose of febuxostat 240 mg per day, 94% of patients were able to reduce their serum uric acid below 6 mg/dL, the threshold needed to prevent precipitation of uric acid crystals. However, the maximum daily dose recommended in the product information for Uloric (febuxostat) is 80 mg, at which approximately 24% of patients failed to lower their serum uric acid levels to less than 6 mg/dL.
When encountering such patients in clinical practice, would the authors advise pushing the daily dose of febuxostat up to 240 mg, if needed? Alternatively, is there any role for combination therapy with both febuxostat and allopurinol for gout patients with severe resistant hyperuricemia?