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Metformin possesses anti-inflammatory and metabolic regulatory properties that may offer additional benefit when combined with febuxostat.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the therapeutic efficacy of adding metformin to febuxostat in patients with gout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A randomized, double-blinded, controlled clinical trial was conducted on 60 gout patients and were randomly assigned to receive either febuxostat and placebo (control group, n\u2009=\u200930) or febuxostat plus metformin (metformin group, n\u2009=\u200930). Clinical assessment included the visual analogue scale (VAS) for pain, while laboratory evaluation comprised serum uric acid, tumor necrosis factor alpha (TNF-\u03b1), interleukin (IL)-1\u03b2, and free fatty acids. All biomarkers except free fatty acids were measured using ELISA; free fatty acids were determined colorimetrically. Lipid profile parameters were also recorded. Adverse effects were monitored in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups showed significant reduction in all measured markers. The addition of metformin resulted in significantly greater reductions in VAS scores (\u2212\u200933.3%), TNF-\u03b1 (\u2212\u200945.3%), IL-1\u03b2 (\u2212\u200912.3%), and uric acid levels (\u2212\u200912.5%) compared with control group (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). The metformin group also demonstrated a significant decrease in free fatty acids (\u2212\u20096.2%) with\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032 and triglycerides (\u2212\u200910.6%) with\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002. No significant differences were observed regarding the frequency of drug-related side effects (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Metformin as an adjuvant to febuxostat provides superior improvement in pain, inflammatory markers, uric acid levels, and metabolic parameters in gout patients, without increasing adverse effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10787-026-02255-w","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:14:08Z","timestamp":1780128848000},"page":"4895-4908","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metformin repurposing in gout: enhancing febuxostat efficacy through anti-inflammatory and metabolic modulation: a randomized controlled double-blind study"],"prefix":"10.1007","volume":"34","author":[{"given":"Dalia N.","family":"Abdel-Sadek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek M.","family":"Abd-Elazez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar M.","family":"El-Haggar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"issue":"1","key":"2255_CR1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.4078\/jrd.2024.0054","volume":"32","author":"EY Ahn","year":"2025","unstructured":"Ahn EY, So MW (2025) The pathogenesis of gout. 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