Gout prevention (urate-lowering therapy)

Long-term therapy aimed at lowering serum urate below the target threshold (under 6 mg/dL; under 5 mg/dL in severe tophaceous gout). EULAR 2016 and ACR 2020 set allopurinol with dose titration as first-line; febuxostat is used when allopurinol is intolerable or the target is not reached. The goal is preventing recurrent flares and tophi formation, not immediate pain relief. Urate-lowering agents are not started during an acute flare, but they are not stopped in patients already on them.

ICD-10 M10.91 drug

Also known as: Urate-lowering therapy, Chronic gout

Drugs used for this condition

AFebuxostatSecond line · Selective xanthine oxidase inhibitorSecond-line agent in gout after allopurinol per EULAR 2016 and ACR 2020. Used with allopurinol intolerance, inadequate response on maximum tolerated allopurinol dose, or in HLA-B*5801 positive status (raised risk of allopurinol hypersensitivity). Standard dose 80 mg once daily; up-titrate to 120 mg if target urate is not reached. Goal: serum urate under 6 mg/dL (under 5 mg/dL in severe tophaceous gout). The CARES trial (2018) showed higher cardiovascular mortality versus allopurinol – indications have since been narrowed.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit