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According to American College of Rheumatology guidelines, allopurinol is the preferred first-line urate-lowering agent (NEJM JW Gen Med Jul 1 2020 and Arthritis Rheumatol 2020; 72:879). An alternative is febuxostat, another xanthine oxidase inhibitor that is considerably more expensive.
In previous efficacy trials comparing the two drugs, allopurinol-treated patients received a maximal dose of 300 mg, rather than dose titration to achieve serum urate targets. In this new double-blind noninferiority trial, researchers randomized 950 patients with gout, hyperuricemia, and estimated glomerular filtration rate (eGFR) ≥30 mL/minute/1.73 m2 to receive either allopurinol or febuxostat; the drugs were titrated to achieve serum urate levels <6.0 mg/d…