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One participant initially in the placebo group had a hypersensitivity reaction with rash, fever and mild transaminitis leading to discontinuation of allopurinol at day 30 (), and we have excluded from the data analysis as both placebo and allopurinol were given to this participant.

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RCT (the urate lowering efficacy and safety of febuxostat in the treatment of hyperuricaemia of gout (CONFIRMS) trial) including 2269 participants with gout (as per ARA criteria) that compared allopurinol 200 or 300 mg daily (depending on renal function) with febuxostat 40 or 80 mg daily, over six months and outcomes were assessed every two months for six months in total.

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The ACR gout guidelines suggest that urate-lowering therapy could be started during an acute gout attack, providing that effective acute management is instituted, and these recommendations are based on "consensus opinion of experts, case studies, or standard of care", rather than RCT evidence, as we have shown ().

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This is consistent with our results comparing allopurinol with febuxostat 120 and 240 mg for acute gout attacks and our results comparing allopurinol with febuxostat 80, 120 and 240 mg for achieving the target serum urate.

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Otherwise similar considerations to the above recommendations for treating patients with gout govern the regulation of dosage for maintenance purposes in secondary hyperuricemia.

No adverse effects were reported.

We reviewed titles and abstracts and, if more information was required to determine whether a trial met the inclusion criteria, we obtained the full text.

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The medication is used to treat diseases accompanied by hyperuricemia: gout (primary and secondary), nephrolithiasis (forming of kidney stones from urates); hyperuricemia (abnormally high level of uric acid in blood, both primary and secondary), which results in diseases involving enhanced dissolution of nucleoproteins and elevated levels of uric acid in the blood, including at various forms of leukemias, and also for treatment of some other conditions.

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Allopurinol kann nicht bei Patienten mit einer überempfindlichen Reaktion auf das Medikament, mit Leber- oder Niereninsuffizienz, primärer Hämochromatose, asymptomatischer Hyperurikämie, akuter Gicht und während der Schwangerschaft oder während der Stillzeit angewendet werden.

However, we found no between-group differences between allopurinol up to 300 mg daily and febuxostat 80 mg daily with respect to acute gout attacks and no between-group differences between allopurinol 200 or 300 mg daily and febuxostat 40 mg daily with respect to serum urate normalisation.

After 10 days, participants in the placebo arm were also started on allopurinol 300 mg daily.

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