From the Guidelines
Uloric (febuxostat) is indicated for the chronic management of hyperuricemia in patients with gout, but its use in geriatric patients with kidney disease requires caution, with a recommended starting dose of less than 40 mg/day, as suggested by the 2020 American College of Rheumatology guideline for the management of gout 1. When considering the use of Uloric in geriatric patients with kidney disease, it is essential to weigh the benefits of reducing gout flares and tophi development against the potential risks, including cardiovascular events and liver abnormalities.
- Key considerations for using Uloric in this population include:
- Starting with a low dose, less than 40 mg/day, to minimize the risk of adverse effects
- Monitoring kidney function, liver enzymes, and cardiovascular status regularly
- Informing patients about potential side effects, including liver abnormalities, rash, and cardiovascular symptoms
- Using a treat-to-target management strategy, with ULT dose titration guided by serial serum urate measurements, aiming for an SU target of <6 mg/dl, as recommended by the 2020 American College of Rheumatology guideline 1. The 2020 American College of Rheumatology guideline for the management of gout strongly recommends using a low starting dose of febuxostat, particularly in patients with moderate-to-severe chronic kidney disease (CKD; stage >3) 1.
- In terms of safety, while Uloric carries a boxed warning for increased risk of cardiovascular death compared to allopurinol, the benefits of reducing gout flares and tophi development may outweigh the risks in some patients, particularly those with severe gout or tophaceous gout. However, the use of Uloric in geriatric patients with kidney disease should be individualized, taking into account the patient's overall health status, kidney function, and potential for adverse effects, with careful monitoring and dose adjustment as needed, as suggested by the 2020 American College of Rheumatology guideline for the management of gout 1.
From the Research
Indication for Chronic Use
- Uloric (febuxostat) is indicated for the chronic management of hyperuricemia in patients with gout 2, 3, 4.
- It is a non-purine selective xanthine oxidase inhibitor that decreases serum uric acid production 3, 4.
- Febuxostat has been shown to be effective in lowering serum uric acid levels and reducing gout flares in patients with chronic gout 2, 5, 6.
Safety in Geriatric Patients with Kidney Disease
- Febuxostat does not require dosage adjustment in patients with mild or moderate renal impairment 2, 3, 6.
- It has been shown to be effective and well-tolerated in patients with renal impairment, including those with chronic kidney disease 2, 5.
- However, patients should be monitored for signs and symptoms of myocardial infarction and stroke, as well as liver function abnormalities, which have been reported as adverse events in clinical trials 3, 6.
- The safety of febuxostat in geriatric patients with kidney disease has not been specifically studied, but it has been shown to be well-tolerated in elderly patients in general 3, 6.