A 45-year-old man with known gout has a serum uric acid of 620 µmol/L despite allopurinol 300 mg/day. He is intolerant to higher doses of allopurinol (creatinine 155 µmol/L, eGFR 48). The MOST appropriate next urate-lowering option is:
- A Benzbromarone (uricosuric agent)
- B Rasburicase (recombinant urate oxidase)
- C Febuxostat (non-purine XO inhibitor) ✓
- D Probenecid
Explanation
Febuxostat is a non-purine selective xanthine oxidase inhibitor that does not require dose adjustment for mild-to-moderate CKD (eGFR >30), unlike allopurinol which requires dose reduction in CKD. It is the preferred alternative when allopurinol is insufficient or not tolerated. The FACT and CONFIRMS trials demonstrated febuxostat 80/120 mg is superior to allopurinol 300 mg in uric acid lowering. Rasburicase is used for tumour lysis syndrome (parenteral, expensive) and benzbromarone is not available in India/many markets and is hepatotoxic. Probenecid is less effective in CKD (eGFR <30) due to reduced tubular secretion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.