ArticleClinical pharmacology and therapeutics2026
Cardiovascular Safety of Febuxostat vs. Allopurinol in Gout Patients with Cardiovascular Diseases: A Target Trial Emulation.
Article in Clinical pharmacology and therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
6 authors.
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Abstract
Guidelines recommend febuxostat and allopurinol as first-line urate-lowering therapies (ULTs) for gout, yet the cardiovascular safety of febuxostat remains debated, with conflicting randomized trials (CARES, FAST) results and limited real-world evidence in high-risk patients. This target trial emulation study evaluated the long-term cardiovascular safety of febuxostat vs. allopurinol in gout patients with preexisting cardiovascular disease (CVD) using US collaborative electronic health records. We included 7555 propensity-score matched (42 covariates) pairs of adults aged ≥ 50 years initiating either febuxostat or allopurinol. The primary outcome of our study was the occurrence of major adverse cardiovascular events (MACE) and the secondary outcome was all-cause mortality. During a 10-year follow-up period (median 1,558 days), MACE risk was comparable (HR: 1.027; 95% CI: 0.978-1.079) between the two groups. Febuxostat was associated with modestly increased all-cause mortality (HR: 1.125; 95% CI: 1.039-1.217). Risk elevations were consistent across subgroups (White race, males, nonsmokers, etc.). Sensitivity analyses confirmed robustness. Findings suggest cautious febuxostat use in CVD patients, guiding personalized prescribing based on racial and lifestyle factors.
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