{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T21:02:41Z","timestamp":1776200561438,"version":"3.50.1"},"reference-count":14,"publisher":"The Journal of Rheumatology","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2011,9]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>Allopurinol, a purine base analog inhibitor of xanthine oxidase (XO) activity, remains the standard for pharmacologic urate-lowering management of gout. Allopurinol is efficacious and safe in most patients, but intolerance is estimated to occur in up to 10% of treated patients. Severe or life-threatening allopurinol adverse reactions (AE) occur much less frequently, and include severe cutaneous allopurinol reactions, vasculitis, and\/or a multisystem allopurinol hypersensitivity syndrome. During clinical development of febuxostat (FEB), a recently approved non-purine analog inhibitor of XO, subjects with severe allopurinol intolerance were excluded from randomized double-blind FEB\/allopurinol comparative trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>In this retrospective study, safety and urate-lowering efficacy of FEB was assessed in 13 successively encountered gout patients with prior documented severe allopurinol reactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>FEB was well tolerated in 12 of 13 patients, each of whom remains on treatment. One patient previously hospitalized with documented exfoliative erythroderma during allopurinol treatment, developed biopsy-confirmed cutaneous leukocytoclastic vasculitis. None of the other 12 patients treated with FEB showed rash, worsening hepatic function, blood cytopenia or eosinophilia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>In 12 of our 13 gout patients with previously documented severe allopurinol AE, FEB treatment was safe. However, the development of a hypersensitivity type cutaneous vasculitis (likely but not definitively FEB-related) early in treatment mandates caution, careful dose escalation, and close monitoring when FEB urate-lowering therapy of allopurinol-intolerant patients is considered.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.110092","type":"journal-article","created":{"date-parts":[[2011,7,4]],"date-time":"2011-07-04T08:20:12Z","timestamp":1309767612000},"page":"1957-1959","source":"Crossref","is-referenced-by-count":100,"title":["Safety and Efficacy of Febuxostat Treatment in Subjects with Gout and Severe Allopurinol Adverse Reactions"],"prefix":"10.3899","volume":"38","author":[{"given":"SAIMA","family":"CHOHAN","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2262","published-online":{"date-parts":[[2011,7,1]]},"reference":[{"key":"2018112909265776000_38.9.1957.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.40.3.245"},{"issue":"Suppl","key":"2018112909265776000_38.9.1957.2","first-page":"S672","article-title":"The incidence of allopurinol hypersensitivity syndrome: a population perspective [abstract]","volume":"58","author":"Khanna","year":"2008","journal-title":"Arthritis Rheum"},{"key":"2018112909265776000_38.9.1957.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780200320"},{"key":"2018112909265776000_38.9.1957.4","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(84)90743-5"},{"key":"2018112909265776000_38.9.1957.5","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0409500102"},{"key":"2018112909265776000_38.9.1957.6","first-page":"385","article-title":"Allopurinol hypersensitivity syndrome: a preventable severe cutaneous reaction?","volume":"49","author":"Lee","year":"2008","journal-title":"Singapore Med J"},{"key":"2018112909265776000_38.9.1957.7","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780290111"},{"key":"2018112909265776000_38.9.1957.8","first-page":"1646","article-title":"Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout","volume":"33","author":"Dalbeth","year":"2006","journal-title":"J Rheumatol"},{"key":"2018112909265776000_38.9.1957.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2007.00270.x"},{"key":"2018112909265776000_38.9.1957.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard.60.10.981"},{"key":"2018112909265776000_38.9.1957.11","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-009-0019-z"},{"key":"2018112909265776000_38.9.1957.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050373"},{"key":"2018112909265776000_38.9.1957.13","doi-asserted-by":"publisher","DOI":"10.1002\/art.24209"},{"key":"2018112909265776000_38.9.1957.14","doi-asserted-by":"publisher","DOI":"10.1002\/art.23068"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.110092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T13:02:18Z","timestamp":1543496538000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.110092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,7,1]]},"references-count":14,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2011,9,1]]},"published-print":{"date-parts":[[2011,9]]}},"alternative-id":["10.3899\/jrheum.110092"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.110092","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7,1]]}}}