In this article on febuxostat for gout in the Drug and Therapeutics Bulletin (DTB), the authors discuss the following topics:

• Hyperuricaemia and gout
• Management of gout
• Non-drug treatment
• Drug treatment
• What is febuxostat?
• Trials of febuxostat versus placebo/allopurinol
• Limitations of the trials
• Unwanted effects
• Cautions and contraindications
• Costs
• Guidelines

The bulletin concludes that for most patients with chronic gout, allopurinol should be used first line in preference to febuxostat, and that the recommendation from NICE and an international position paper to restrict use of febuxostat to patients who are intolerant of allopurinol, or for whom allopurinol is contraindicated or ineffective when optimally administered; seems sensible on the basis of current limited evidence.