Febuxostat vs allopurinol
What are the differences between Uloric (febuxostat) and allopurinol? Philip Ng, MD, Port Coquitlam, BC
The biggest difference between the two is probably cost. Both are xanthine oxidase inhibitors, where allopurinol is a purine analog and uloric is a non-purine compound. The main difference between the two is the route of elimination, with Uloric having dual elimination (hepatic and renal ~50% each) compared to allopurinol (mainly renal ~80%) and therefore Uloric doesn’t require dosage adjustment in mild to moderate renal or hepatic dysfunction. In short-term studies, uloric 80 mg/day was found to be more effective in reducing serum uric acid than allopurinol 300 mg/day, with 67% of patients reaching target with Uloric compared to 47% patients with allopurinol at 6-months (CONFIRMS). However, there were higher (but not statistically significant) rates of cardiovascular events, (cardiovascular deaths, non-fatal myocardial infarctions, and non-fatal strokes) in patients treated with Uloric [0.74 per 100 P-Y (95% CI 0.36-1.37)] than allopurinol [0.60 per 100 P-Y (95% CI 0.16-1.53)].