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Safety and tolerability of available urate-lowering drugs: a critical review.
Expert Opin Drug Saf 2019; 18(4):261-271EO

Abstract

INTRODUCTION

Urate-lowering therapy (ULT) is the cornerstone of gout management, which is a widespread chronic illness characterized by hyperuricemia, arthropathy, tophus development, and urolithiasis. Since asymptomatic increased serum urate levels are associated with a higher risk of cardiovascular, renal and metabolic disorders, a larger use of ULTs in the general population is expected in the near future.

AREAS COVERED

This review will focus on the safety and tolerability profile of the available urate-lowering drugs: xanthine oxidase inhibitors (XOIs), uricosuric agents and injectable uricases.

EXPERT OPINION

Older drugs for ULT like allopurinol are well studied and extensively described from typical adverse effects (mild skin rash) to unusual fatal reactions, while febuxostat seems to be overall well tolerated. More evidence is required to define the safety profile of topiroxostat, arhalofenate, tranilast, and sulfinpyrazone. Furthermore, there are some unanswered questions about the pharmacological interactions of probenecid and the hepatotoxicity of benzbromarone. Despite a limited use in clinical practice, combination therapy with lesinurad or verinurad and XOI is not frequently accompanied by side effects. Rasburicase and pegloticase are usually well tolerated with some specific exceptions. Before prescribing UL drugs, physicians should take into account their safety profile tailoring the treatment on the patient characteristics.

Authors+Show Affiliations

a Department of Therapy and Medical Diagnostics , Lviv National Medical University , Lviv , Ukraine.b Medical and Surgical Sciences Department , Alma Mater Studiorum University of Bologna , Bologna , Italy.b Medical and Surgical Sciences Department , Alma Mater Studiorum University of Bologna , Bologna , Italy. c Medical and Surgical Sciences Department , Sant'Orsola-Malpighi University Hospital , Bologna , Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30915866

Citation

Strilchuk, Larysa, et al. "Safety and Tolerability of Available Urate-lowering Drugs: a Critical Review." Expert Opinion On Drug Safety, vol. 18, no. 4, 2019, pp. 261-271.
Strilchuk L, Fogacci F, Cicero AF. Safety and tolerability of available urate-lowering drugs: a critical review. Expert Opin Drug Saf. 2019;18(4):261-271.
Strilchuk, L., Fogacci, F., & Cicero, A. F. (2019). Safety and tolerability of available urate-lowering drugs: a critical review. Expert Opinion On Drug Safety, 18(4), pp. 261-271. doi:10.1080/14740338.2019.1594771.
Strilchuk L, Fogacci F, Cicero AF. Safety and Tolerability of Available Urate-lowering Drugs: a Critical Review. Expert Opin Drug Saf. 2019;18(4):261-271. PubMed PMID: 30915866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and tolerability of available urate-lowering drugs: a critical review. AU - Strilchuk,Larysa, AU - Fogacci,Federica, AU - Cicero,Arrigo Fg, Y1 - 2019/03/27/ PY - 2019/3/28/pubmed PY - 2019/5/17/medline PY - 2019/3/28/entrez KW - Allopurinol KW - benzbromarone KW - febuxostat KW - gout KW - lesinurad KW - pegloticase KW - probenecid KW - rasburicase KW - safety SP - 261 EP - 271 JF - Expert opinion on drug safety JO - Expert Opin Drug Saf VL - 18 IS - 4 N2 - INTRODUCTION: Urate-lowering therapy (ULT) is the cornerstone of gout management, which is a widespread chronic illness characterized by hyperuricemia, arthropathy, tophus development, and urolithiasis. Since asymptomatic increased serum urate levels are associated with a higher risk of cardiovascular, renal and metabolic disorders, a larger use of ULTs in the general population is expected in the near future. AREAS COVERED: This review will focus on the safety and tolerability profile of the available urate-lowering drugs: xanthine oxidase inhibitors (XOIs), uricosuric agents and injectable uricases. EXPERT OPINION: Older drugs for ULT like allopurinol are well studied and extensively described from typical adverse effects (mild skin rash) to unusual fatal reactions, while febuxostat seems to be overall well tolerated. More evidence is required to define the safety profile of topiroxostat, arhalofenate, tranilast, and sulfinpyrazone. Furthermore, there are some unanswered questions about the pharmacological interactions of probenecid and the hepatotoxicity of benzbromarone. Despite a limited use in clinical practice, combination therapy with lesinurad or verinurad and XOI is not frequently accompanied by side effects. Rasburicase and pegloticase are usually well tolerated with some specific exceptions. Before prescribing UL drugs, physicians should take into account their safety profile tailoring the treatment on the patient characteristics. SN - 1744-764X UR - https://www.unboundmedicine.com/medline/citation/30915866/Safety_and_tolerability_of_available_urate-lowering_drugs:_a_critical_review L2 - http://www.tandfonline.com/doi/full/10.1080/14740338.2019.1594771 DB - PRIME DP - Unbound Medicine ER -