Thomas Bardin1, Gérard Chalès2, Tristan Pascart3, René-Marc Flipo3, Hang Korng Ea4, Jean-Claude Roujeau5, Aurélie Delayen6, Pierre Clerson6. 1. Rheumatology department, Viggo Petersen center, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Inserm, UMR 1132, 75010 Paris, France. Electronic address: thomas.bardin@lrb.aphp.fr. 2. Rheumatology department, University of Rennes 1, hôpital Sud, CHU de Rennes, Rennes, France. 3. Rheumatology department, University Hospital of Lille, and University of Lille 2, 59000 Lille, France. 4. Rheumatology department, Viggo Petersen center, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Inserm, UMR 1132, 75010 Paris, France. 5. Université Paris-Est Créteil, 94000 Créteil, France. 6. Orgamétrie biostatistiques, 59512 Roubaix, France.
Abstract
OBJECTIVE: To investigate the cutaneous tolerance of febuxostat in gouty patients with skin intolerance to allopurinol. METHODS: We identified all gouty patients who had sequentially received allopurinol and febuxostat in the rheumatology departments of 4 university hospitals in France and collected data from hospital files using a predefined protocol. Patients who had not visited the prescribing physician during at least 2 months after febuxostat prescription were excluded. The odds ratio (OR) for skin reaction to febuxostat in patients with a cutaneous reaction to allopurinol versus no reaction was calculated. For estimating the 95% confidence interval (95% CI), we used the usual Wald method and a bootstrap method. RESULTS: In total, 113 gouty patients had sequentially received allopurinol and febuxostat; 12 did not visit the prescribing physician after febuxostat prescription and were excluded. Among 101 patients (86 males, mean age 61±13.9 years), 2/22 (9.1%) with a history of cutaneous reactions to allopurinol showed skin reactions to febuxostat. Two of 79 patients (2.5%) without a skin reaction to allopurinol showed skin intolerance to febuxostat. The ORs were not statistically significant with the usual Wald method (3.85 [95% CI 0.51-29.04]) or bootstrap method (3.86 [95% CI 0.80-18.74]). CONCLUSION: The risk of skin reaction with febuxostat seems moderately increased in patients with a history of cutaneous adverse events with allopurinol. This moderate increase does not support the cross-reactivity of the two drugs.
OBJECTIVE: To investigate the cutaneous tolerance of febuxostat in gouty patients with skin intolerance to allopurinol. METHODS: We identified all gouty patients who had sequentially received allopurinol and febuxostat in the rheumatology departments of 4 university hospitals in France and collected data from hospital files using a predefined protocol. Patients who had not visited the prescribing physician during at least 2 months after febuxostat prescription were excluded. The odds ratio (OR) for skin reaction to febuxostat in patients with a cutaneous reaction to allopurinol versus no reaction was calculated. For estimating the 95% confidence interval (95% CI), we used the usual Wald method and a bootstrap method. RESULTS: In total, 113 gouty patients had sequentially received allopurinol and febuxostat; 12 did not visit the prescribing physician after febuxostat prescription and were excluded. Among 101 patients (86 males, mean age 61±13.9 years), 2/22 (9.1%) with a history of cutaneous reactions to allopurinol showed skin reactions to febuxostat. Two of 79 patients (2.5%) without a skin reaction to allopurinol showed skin intolerance to febuxostat. The ORs were not statistically significant with the usual Wald method (3.85 [95% CI 0.51-29.04]) or bootstrap method (3.86 [95% CI 0.80-18.74]). CONCLUSION: The risk of skin reaction with febuxostat seems moderately increased in patients with a history of cutaneous adverse events with allopurinol. This moderate increase does not support the cross-reactivity of the two drugs.