Do you prefer allopurinol or febuxostat for patients with chronic kidney disease who are receiving treatment for asymptomatic hyperuricemia?

Allopurinol. For my Asian and sometimes African American patients, I consider HLA testing to make sure they are not at risk for allopurinol hypersensitivity. In which case, I will prescribe febuxostat. Most often, I find the insurance will not even cover febuxostat unless I have tried allopurinol first.

I also prefer febuxostat over allopurinol. Febuxostat, in my opinion, has a safety advantage over allopurinol, contrary to popular belief and contrary to the black box warning on its package insert.

My greatest concern with allopurinol has been the small risk it poses for Steven's Johnson Syndrome and for toxic epidermal necrolysis, both devastating events. The risk of allopurinol allergy led to the removal of uric acid from automated chemistry panels more than two decades ago.

I have served as a rheumatology expert witness for three lawsuits where allopurinol was associated with life-threatening allergic events and during my medical training, encountered two other cases. These experiences have tempered my enthusiasm for allopurinol and I wel...

I use both but prefer Febuxostat. Multiple recent studies have shown no additional cardiovascular risk of febuxostat compared to Allopurinol. The clear advantage for me is the ease of use compared to Allopurinol. The slow and tedious taper of Allopurinol (from 50 or 100mg, to 300-900 mg to hit the target is fraught with compliance and missteps by the "typical" gout patient. Most Rheums (myself included)) bemoan the fact no matter how intelligent or accomplished a patient with gout may be in their lives, for some odd reason, they constantly are failing in their ability to understand instructions on their gout meds. The simplicity of Febuxostat, 40mg, then 80mg if needed to reach target is a far superior method. Since Uloric went generic, we ...

I too find Febuxostat difficult to get but testing for allopurinol sensitivity is not that easy either. The question I have is in the stem of the question, why are you treating "asymptomatic" hyperuricemia in CKD in the first place?