ArticleNEJM evidence2022
Comparative Effectiveness of Allopurinol and Febuxostat in Gout Management.
Article in NEJM evidence, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT02579096 (CSP #594 - Comparative Effectiveness in Gout), which is not on this map. Cited by 40 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
CSP #594 - Comparative Effectiveness in Gout: Allopurinol vs. Febuxostat
Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it, 93 citations in OpenAlex.
- A systematic review and network meta-analysis of cardiovascular safety of benzbromarone compared to febuxostat and allopurinol in patients with gout.Frontiers in cardiovascular medicine · 2025Pooled it
- Improvements in Health-Related Quality of Life With Treat-to-Target Urate-Lowering Therapy in Gout: A Post Hoc Analysis of a Randomized Multicenter Trial.Arthritis care & research · 2026Trial
- Effective xanthine oxidase inhibitor urate lowering therapy in gout is linked to an emergent serum protein interactome of complement and inflammation modulators.Scientific reports · 2024Trial
- Comparison of Gout Flares With the Initiation of Treat-to-Target Allopurinol and Febuxostat: A Post-Hoc Analysis of a Randomized Multicenter Trial.Arthritis & rheumatology (Hoboken, N.J.) · 2024Trial
- Superiority of Low-Dose Benzbromarone Add-On to Low-Dose Febuxostat Compared With Febuxostat Monotherapy in Gout With Combined-Type Hyperuricemia.Arthritis care & research · 2024Trial
- Determinants of Achieving Serum Urate Goal with Treat-to-Target Urate-Lowering Therapy in Gout.Arthritis & rheumatology (Hoboken, N.J.) · 2024Trial
- Revisiting the Ethics of Urate-Lowering Therapy Clinical Trials for Gout Management.Arthritis & rheumatology (Hoboken, N.J.) · 2026Article
- Advances in the management of gout: From current strategies to emerging therapies.The Journal of international medical research · 2026Review
- Treatment sequence patterns of urate-lowering therapy in Korean patients with gout: A common data model-based study.PloS one · 2026Article
- Peripheral CD4Frontiers in immunology · 2026Article
- Controversies in Urate-Lowering Therapy for Gout: A Comprehensive Review.Gout, urate, and crystal deposition disease · 2025Article
- Comparative Cardiovascular Safety of Nonsteroidal Anti-Inflammatory Drug Versus Colchicine Use When Initiating Urate-Lowering Therapy Among Patients With Gout: Target Trial Emulations.Arthritis & rheumatology (Hoboken, N.J.) · 2025Article
- Importance of Considering the Gout Flare: Let's Learn to Walk and Chew Gum at the Same Time in Gout Clinical Trial Design.Arthritis & rheumatology (Hoboken, N.J.) · 2025Article
- The Role of the Intestinal Microbiome in the Pathogenesis and Treatment of Hyperuricemia: A Review.Food science & nutrition · 2025Review
- Risk of Hepatotoxicity in Patients With Gout Treated With Febuxostat or Benzbromarone: A Propensity Score-Matched Cohort Study.Arthritis care & research · 2025Article
- [Diagnostics and treatment of gout : Short version of the German S3 guideline].Zeitschrift fur Rheumatologie · 2025Review
- Review
- Gout therapy updated.Therapeutic advances in musculoskeletal disease · 2025Review
- Combination of sodium-glucose cotransporter type 2 inhibitors and urate-lowering therapy in people with gout from a specialist clinic: a retrospective, single-center observational study.Frontiers in medicine · 2025Article
- Dual-drug nanocarriers for gout therapy: targeted co-delivery of anti-inflammatory and urate-lowering agents: a review.EXCLI journal · 2025Review
Corrections and comments
- Erratum issued
- Erratum issued
Authors and funding
17 authors at 11 institutions in 1 country.
Funding
Abstract
backgroundThe relative efficacy and safety of allopurinol and febuxostat when used according to current guidelines for the treatment of hyperuricemia are unknown. This double-blind noninferiority trial examined these issues.
methodsParticipants with gout and hyperuricemia (with at least 33% having stage 3 chronic kidney disease) were randomly assigned to allopurinol or febuxostat in this 72-week trial, with doses titrated to target serum urate. The trial had three phases: titration (weeks 0 to 24), maintenance (weeks 25 to 48), and observation (weeks 49 to 72). Allopurinol and febuxostat were initiated at daily doses of 100 and 40 mg, with maximum titration to 800 and 120 mg, respectively. Antiinflammatory prophylaxis was given during phases 1 and 2. The primary end point was the proportion of patients experiencing one or more flares during phase 3, with a prespecified noninferiority margin of less than 8 percentage points between allopurinol and febuxostat. Secondary end points included efficacy in patients with chronic kidney disease, proportion achieving target serum urate levels, and serious adverse events.
resultsThis study included 940 participants; 20.1% withdrew, with similar proportions in treatment arms. During phase 3, 36.5% of allopurinol-treated participants had one flare or more compared with 43.5% of febuxostat-treated participants (P<0.001 for noninferiority). Overall, 80% of participants achieved mean target urates during phase 2 with no differences by treatment. There were no treatment differences (including cardiovascular events) in serious adverse events.
conclusionsAllopurinol and febuxostat achieved serum urate goals in patients with gout; allopurinol was noninferior to febuxostat in controlling flares. Similar outcomes were noted in participants with stage 3 chronic kidney disease. (Funded by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development; ClinicalTrials.gov identifier, NCT02579096.).
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.