From Hyperuricemia to
gout
ENDY ADNAN
HYPERURICEMIA
Hyperuricemia occurs when uric acid levels in the blood
are too high (above 6 mg/dl).
Hyperuricemia occurs when the food consumed contains
high purine substances.
• There are 2 kinds:
Asymptomatic hyperuricemia: no symptoms or signs of
disease
Symptomatic hyperuricemia: there are symptoms of
inflammation & pain
From Hyperuricemia to
GOUT
• The first step is the development of
hyperuricaemia
• In some individuals with
hyperuricaemia, monosodium urate
(MSU) crystal deposition occurs,
• and in some individuals with MSU
crystal deposition, the clinical
manifestations of gout (gout flares,
chronic gouty arthritis and tophaceous
gout) occur.
• Urolithiasis, interstitial deposition of
urate crystals in renal parenchyma,
and uric acid nephropathy may
develop in some patients.
TREAT TO TARGET
Inflammasome Increased
with acute Gout
FEBUXOSTATE ALLOPURINOL
CHEMICAL STRUCTURE & Non Purine Purine Analog
ACTIVITY Selective Inhibitor of Xanthine Non Selective Inhibitor of
Oxidase Xanthine Oxidase
EFFICACY Effective at achieving <6mg/dl Minimally effective at
decreasing SUA <6mg/dl
(dose < 300mg)
EXCRETION Primarily in the Faeces (GI Primarily in the Urine (Kidney)
tract)
DOSING Effective at the lowest dose Need to be uptitrated (from
(40mg) 100mg)
DOSING IN RENAL No dosage adjustment Need dosage adjustment
INSUFFICIENCY
DOSING IN ELDERLY No dosage adjustment Need dosage adjustment
Rheumatology 2009;48:188–194
Terapi Febuxostat jangka panjang (5th)
Efektif menjaga kadar as urat < 6 mg/dl
Efektif mengurangi serangan GOUT
Efektif mengurangi tophy
Febuxostat lebih poten
dibandingkan Alopurinol
Jackson et al. BMC Geriatrics 2012, 12:11
Febuxostat lebih poten
dibandingkan Alopurinol
Perbandingan
efektifitas
ALOPURINOL Penurunan
300mg 30%
FEBUXOSTAT Penurunan
40mg 40%
FEBUXOSTAT Penurunan
80mg 50%
Conclusion: Febuxostat demonstrated renal safety
and good urate lowering efficacy in GOUT patients
with stage 4-5 CKD
Effects of Febuxostate on Mortality and Cardiovascular Outcomes
A Systemic Review and Meta Analysis of RTC
Mayo Clin Proc Inn Qual Out n August 2020;4(4):434-442
A total of 15 randomized controlled trials
(16,070 participants) were included
• Conclusion: This meta-analysis
suggested that use of febuxostat
was not associated with higher
risk of mortality or adverse
cardiovascular outcomes in
patients with gout and
hyperuricemia
Pasien Kardiovaskuler dan Gangguan Ginjal Resiko hipersensitif
Alopurinol
CONCLUSION
• Allopurinol first indicated in gout patients, but the target serum urate
level is not always achieve
• Allopurinol may induce severe allergic reactions that are life threatening,
like toxic epidermal necrolysis and Steven Johnson Syndrome, for risk
factors HLA B*5801 (+), renal impairment and age >65 yr
• Febuxostat is a new treatment option for hyperuricemia & gout with its
proven efficacy and convenience at use
• Febuxostat was significantly more efficacious in l;owering serum urate
levels to <6 mg/dL compared to allopurinol 300 mg/200 mg in patients
who had gout with mild and moderate renal impairment
