From the Guidelines
Febuxostat should not be stopped even if gout symptoms are stable, as discontinuing the medication can lead to a rebound increase in uric acid levels, triggering new gout attacks. The medication is intended for long-term use to maintain uric acid levels below the target of 6.0 mg/dL and prevent future gout flares. Some key points to consider:
- Discontinuing febuxostat can lead to a rebound increase in uric acid levels, which can trigger new gout attacks, even after a period of symptom stability 1.
- The absence of symptoms does not mean the underlying hyperuricemia has resolved, and periodic uric acid monitoring may be necessary to ensure levels remain controlled 1.
- Some patients with years of well-controlled uric acid levels and no tophi (urate deposits) might eventually discuss dose reduction with their doctor, but complete discontinuation is generally not recommended 1.
- The medication works by inhibiting xanthine oxidase, the enzyme responsible for uric acid production, addressing the root cause of gout rather than just treating symptoms 1. It is essential to consult with a healthcare provider before stopping febuxostat, as they may recommend periodic uric acid monitoring to ensure levels remain controlled.
From the Research
Stopping Febuxostat for Stable Symptoms
- There is no direct evidence in the provided studies to suggest that febuxostat can be stopped if symptoms are stable 2, 3, 4, 5, 6.
- However, long-term treatment with febuxostat for up to 4 years or more has been shown to reduce the incidence of gout flares to (or close to) zero 3.
- Sustained reduction in serum uric acid level with febuxostat therapy has been associated with near elimination of gout flares and improved tophus status 4.
- The decision to stop febuxostat should be made on a case-by-case basis, taking into account the individual patient's response to treatment and potential risks of stopping therapy.
- It is essential to monitor patients for signs and symptoms of myocardial infarction and stroke, as well as liver function abnormalities, when stopping febuxostat 2, 5.
Considerations for Stopping Febuxostat
- Patients with stable symptoms may still require ongoing treatment to maintain serum uric acid levels below 6 mg/dL 3, 4.
- Stopping febuxostat may lead to an increase in serum uric acid levels, potentially resulting in gout flares or other complications 3, 4.
- The safety and efficacy of stopping febuxostat have not been extensively studied, and more research is needed to determine the optimal treatment duration and discontinuation strategy 2, 3, 4, 5, 6.