{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:00:37Z","timestamp":1790150437224,"version":"4.0.1"},"reference-count":60,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since gout is a common metabolic arthritis caused by urate crystal deposition, urate\u2010lowering therapy (ULT) is clearly indicated, but the initiation of ULT frequently causes paradoxical acute flares that in turn impair patient adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study sought to assess the effectiveness and safety of an ultra\u2010low\u2010dose initiation strategy for febuxostat (10\u2009mg\/day) compared to the standard starting dose (20\u2009mg\/day) in reducing initiation\u2010related flares while maintaining long\u2010term urate control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>120 male patients with primary gout presenting with acute arthritis were randomly assigned to initiate febuxostat at 10\u2009mg\/day (Group A) or 20\u2009mg\/day (Group B), with protocol\u2010mandated biweekly titration. The primary outcomes were gout flare frequency over 24\u2009weeks (assessed using Poisson regression), serum uric acid (SUA) target attainment, and the incidence of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Although both groups achieved comparable target SUA levels by week 24, Group A demonstrated a significantly lower overall flare incidence (36.7% vs. 70.0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), along with a greater percentage of flare\u2010free patients (70.0% vs. 46.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). Multivariable Poisson regression revealed that Group B had an approximately twofold higher risk of flares compared to Group A (Incidence Rate Ratio\u2009=\u20091.95;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012), with obese patients deriving the most pronounced benefit from the ultra\u2010low\u2010dose approach. To avert one additional flare, the calculated number needed to treat was 4.3. Additionally, the occurrence of clinically significant liver injury (ALT\/AST &gt;\u20093\u00d7 ULN) was low in both groups, with 3.3% in Group A and 1.7% in Group B. Multivariable regression analysis confirmed that LDL\u2010C is an independent predictor of ALT (\u03b2\u2009=\u200912.90,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009), while febuxostat dosage was not linked to hepatotoxicity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Initiating febuxostat at a dose of 10\u2009mg\/day with gradual titration demonstrates a superior safety profile by effectively reducing early acute flares without compromising long\u2010term urate control, which is particularly advantageous for high\u2010risk cohorts, including obese patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1756-185x.70800","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:16:57Z","timestamp":1788779817000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and Safety of Ultra\u2010Low Starting Dose Febuxostat Titration in Male Patients With Primary Gout"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3036-1222","authenticated-orcid":false,"given":"Sun","family":"Huizhen","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology General Hospital of Northern Theater Command  Shenyang City Liaoning Province China"},{"name":"Graduate School Dalian Medical University  Dalian City Liaoning Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yadi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology General 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