Multiple choice question
Which of the following is a first-line pharmacotherapy for gout and hyperuricemia?
A) Febuxostat
B) Probenecid
C) Allopurinol
D) Benzbromarone
Correct answer
C) Allopurinol
Explanation
- Allopurinol is recommended as the first-line urate-lowering therapy for patients with gout, including those with chronic kidney disease (CKD) stage ≥ 3, according to the ACR 2020 guidelines
- The EULAR 2017 guidelines also recommend initiating allopurinol as first-line urate-lowering therapy in patients with normal kidney function
- The BSR 2017 guidelines suggest initiating allopurinol as first-line urate-lowering therapy at a low dose, with subsequent dose titration to target
- Febuxostat is considered an alternative second-line xanthine oxidase inhibitor in patients not tolerating allopurinol or if renal impairment prevents allopurinol dose escalation sufficient to achieve the therapeutic target
- Probenecid is recommended as the first choice among uricosurics for urate-lowering therapy monotherapy by the ACR 2012 guidelines, but it is not the first-line therapy overall
- Benzbromarone is considered in patients resistant to, or intolerant of, xanthine oxidase inhibitors, according to the BSR 2017 guidelines
In conclusion, allopurinol is the first-line pharmacotherapy for gout and hyperuricemia, as recommended by multiple guidelines