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Updated May 2, 2018, to correct an error in how we presented the data from the study.
Gout brings with it significant comorbidities, which include cardiovascular disease. Although many patients respond well to the purine analogue, allopurinol, physicians also frequently prescribe xanthine oxidase inhibitors to help manage hyperuricemia. Unfortunately, the prescription of xanthine oxidase inhibitors, such as febuxostat, is done in the absence of large, randomized clinical trials examining the cardiovascular safety of this class of drugs.
Recently, William B. White, MD, professor of medicine at the University of Connecticut School of Medicine, and colleagues designed a noninferiority study to compare the cardiovascular safety of febuxostat and allopurinol. They found that, although febuxostat was noninferior to allopurinol with respect to rates of adverse cardiovascular events, all-cause mortality and cardiovascular mortality were higher in the patients treated with febuxostat compared with patients treated with allopurinol. The results of their Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARE) trial were published on March 12 in the New England Journal of Medicine.1