Clinical effectiveness of allopurinol–febuxostat versus allopurinol–colchicine combination therapy in patients with gout: A retrospective study at Universitas Sebelas Maret Hospital, Indonesia
DOI:
https://doi.org/10.35335/midwifery.v14i3.2405Keywords:
Allopurinol, Colchicine, Febuxostat, Gout Hyperuricemia, ObesityAbstract
Background: Gout is a metabolic disorder characterized by elevated serum uric acid levels, which may lead to joint inflammation and decreased quality of life. Combination therapies, including allopurinol–febuxostat and allopurinol–colchicine, are commonly used to control serum uric acid levels and improve clinical outcomes. Objective: This study aimed to compare the clinical effectiveness of allopurinol–febuxostat and allopurinol–colchicine combination therapy in patients with gout. Methods: This retrospective observational study used medical records of patients diagnosed with gout or hyperuricemia at Universitas Sebelas Maret Hospital. A total of 79 patients who met the inclusion criteria were included. Patient characteristics, serum uric acid levels before and after therapy, and follow-up duration were collected and analyzed using comparative statistical tests. Results: The allopurinol–febuxostat group showed a reduction in serum uric acid levels from 7.98 ± 0.50 mg/dL to 5.01 ± 0.53 mg/dL, corresponding to a mean reduction of 2.90 ± 0.62 mg/dL. The allopurinol–colchicine group showed a reduction from 7.98 ± 0.56 mg/dL to 5.24 ± 0.65 mg/dL, with a mean reduction of 2.83 ± 0.58 mg/dL. The between-group mean difference in serum uric acid reduction was 0.07 mg/dL, with a statistically significant difference in treatment effectiveness (p = 0.004). The 95% confidence interval (95% CI: [lower limit] to [upper limit]) and effect size (Cohen's d = [value]) should be reported to indicate the precision and magnitude of the treatment effect. Conclusion: Both combination therapies effectively reduced serum uric acid levels; however, the allopurinol–febuxostat combination demonstrated significantly greater effectiveness than the allopurinol–colchicine combination. Reporting confidence intervals and effect size alongside statistical significance provides a more comprehensive interpretation of the treatment effect.
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Aaditya Shivhare, A. B., & , K. T. Harichandrakumar , Pragya Silwal, P. R. (2022). and using cord blood for transfusion Azikiwe University Teaching Hospital ,. Asian Journal of Transfusion Science, 12(2), 105–111. https://doi.org/10.4103/ajts.AJTS
Abhishek, A., Doherty, M., Kuo, C. F., Mallen, C. D., Zhang, W., & Grainge, M. J. (2017). Rheumatoid arthritis and the epidemiology of gout. Nature Reviews Rheumatology, 13(11), 649–662.
Bardin, T., & Richette, P. (2017). Definition of hyperuricemia and gouty conditions. Current Opinion in Rheumatology, 29(2), 144–148.
Chen, J., Zhang, Y., Wang, Y., & Chen, L. (2025). Comparative efficacy and safety of febuxostat and allopurinol in chronic kidney disease stage 3–5 patients with asymptomatic hyperuricemia: a network meta-analysis. Renal Failure, 47(1). https://doi.org/10.1080/0886022X.2025.2470478
Dalbeth, N., Choi, H. K., Joosten, L. A. B., Khanna, P. P., Matsuo, H., Perez-Ruiz, F., & Stamp, L. K. (2019). Gout. Nature Reviews Disease Primers, 5(1), 69.
Dalbeth, N., Gosling, A. L., Gaffo, A., & Abhishek, A. (2021). Gout. The Lancet, 397(10287), 1843–1855.
Day, R. O., Graham, G. G., Hicks, M., McLachlan, A. J., Stocker, S. L., & Williams, K. M. (2020). Clinical pharmacokinetics and pharmacodynamics of allopurinol and oxypurinol. Clinical Pharmacokinetics, 59(3), 283–299.
Dehlin, M., Jacobsson, L., & Roddy, E. (2020). Global epidemiology of gout: Prevalence, incidence, treatment patterns and risk factors. Nature Reviews Rheumatology, 16(7), 380–390.
Dewi, C., Puspita, F., Puspitasari, I. M., & Zakiyah, N. (2023). Hepatic Safety of Febuxostat and Allopurinol for Gout Patients: A Systematic Review of Randomized Controlled Trial. Therapeutics and Clinical Risk Management, 19(November), 731–743. https://doi.org/10.2147/TCRM.S424598
FitzGerald, J. D., Dalbeth, N., Mikuls, T. (2020). 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care & Research, 72(6), 744–760.
Joseph-Ridge, N. B. M. A. S. H. R. W. R. L. M. P. A. E. D. P. W. A. S. J. & J.-R. Nb. M. A. S. H. R. W. R. L. M. P. A. E. D. P. W. A. S. J. (2005). Febuxostat compared with allopurinol in patients with hyperuricemia and gout. New England Journal of Medicine, 353(23), 2450–2461.
Khanna, D., Fitzgerald, J. D., Khanna, P. P., et al. (2012). 2012 American College of Rheumatology guidelines for management of gout. Arthritis Care & Research, 64(10), 1431–1446.
Kuo, C. F., Grainge, M. J., Zhang, W., & Doherty, M. (2015). Global epidemiology of gout: Prevalence, incidence and risk factors. Nature Reviews Rheumatology, 11(11), 649–662.
Leung, Y. Y., Hui, L. L., & Kraus, V. B. (2015). Colchicine—Update on mechanisms of action and therapeutic uses. Seminars in Arthritis and Rheumatism, 43(3), 341–351.
Mackenzie, I. S., Ford, I., Nuki, G., Hall, C. L., et al. (2020). Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): A multicentre, prospective, randomised, open-label, non-inferiority trial. The Lancet, 396, 1745–1757.
Neogi, T. (2011). Gout. Clinical Practice. Gout. New England Journal of Medicine, 364(5), 443–452.
Pascart, T., & Richette, P. (2018). Colchicine in gout: An update. Current Pharmaceutical Design, 24(6), 684–689.
Prihantinah, W., Ayu, R., & Sartika, D. (2025). HUBUNGAN KEPATUHAN MINUM TABLET TAMBAH DARAH TERHADAP KADAR HB / ANEMIA PADA IBU HAMIL. 9(April), 622–630.
Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: An old disease in new perspective. Journal of Advanced Research, 8(5), 495–511.
Redon, J. B. C. A.-R. E. J. R. J. K. J. T. L. E. M. G. P.-R. F. (2020). Hyperuricemia and cardiovascular disease: New perspectives. Journal of Clinical Medicine, 9(6), 1791.
Richette, P., Doherty, M., Pascual, E., et al. (2017). 2016 updated EULAR evidence-based recommendations for the management of gout. Annals of the Rheumatic Diseases, 76(1), 29–42.
Robinson, P. C., Dalbeth, N., & Stamp, L. K. (2021). Treat-to-target in gout: Current evidence and future directions. Rheumatology, 60.
Safiri, S., Kolahi, A. A., Cross, M., Carson-Chahhoud, K., Hoy, D., Almasi-Hashiani, A., et al. (2020). Prevalence, incidence and years lived with disability due to gout and its attributable risk factors: Results from the Global Burden of Disease Study 2017. Arthritis & Rheumatology, 72(11), 1916–1927.
Schumacher, H. R., Becker, M. A., Wortmann, R. L., MacDonald, P. A., Hunt, B., Streit, J., & Joseph-Ridge, N. (2008). Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout. Arthritis & Rheumatism, 59(11), 1540–1548.
Stamp, L. K., & Chapman, P. T. (2017). Allopurinol hypersensitivity: Pathogenesis and prevention. Current Rheumatology Reports, 19(4), 18.
Tardif, J. C., Kouz, S., Waters, D. D., et al. (2019). Efficacy and safety of low-dose colchicine after myocardial infarction. New England Journal of Medicine, 381(26), 2497–2505.
White, W. B., Saag, K. G., Becker, M. A., et al. (2018). Cardiovascular safety of febuxostat or allopurinol in patients with gout. New England Journal of Medicine, 378(13), 1200–1210.
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