Designing a formulary of uric acid production inhibitors for patients in the recovery period through a systematic review.

Abstract

【Background】 Formularies are used for the continuous determination of the appropriateness and cost-effectiveness of medicines. In this study, we designed a formulary of uric acid production inhibitors by performing a systematic review of uric acid production inhibitors. 【Methods】 We designed the formulary as follows: 1) We systematically reviewed studies of comparison of allopurinol and febuxostat published until May 2017. 2) We qualitatively assessed the following end points: prevention of gouty flares, prevention of organ disorders, serum uric acid (UA) level lowering effect, achievement rate of a target serum uric acid level of less than 6.0 mg/dL, and side effects, 3) We decided the priority of use of the medicines by evaluating pharmaceutical equivalents and drug costs. 【Results】 Seven articles were selected. The effects in prevention of organ disorders were similar for both febuxostat and allopurinol. Febuxostat (40 mg/day) or allopurinol (200 or 300 mg/day) had comparable effects in terms of lowering UA levels and the achievement rate of a target UA level of less than 6.0 mg/dL. With regard to the achievement rate of a UA level less than 6.0 mg/dL, febuxostat (80 mg/day or over) showed a higher rate than febuxostat (40 mg/day) or allopurinol (200 or 300 mg/day). No differences in serious side effects were observed between the drugs. In allopurinol responders, the cost of allopurinol was lower than that of febuxostat. 【Conclusion】 In the Niiza Hospital formulary, allopurinol is indicated as the first-line treatment for suppressing uric acid production in patients with hyperuricemia. Febuxostat should only be selected when the effectiveness or tolerability of allopurinol is unsatisfactory.