A comparative study of efficacy and safety of febuxostat and allopurinol in pyrazinamide-induced hyperuricemic tubercular patients

OBJECTIVES: To compare the efficacy and safety of febuxostat and allopurinol in pyrazinamide (PZA)-induced hyperuricemia in patients taking antitubercular therapy (ATT). METHODS: This randomized controlled study was conducted at a tertiary care teaching institute of Rajasthan in all the sputum-positive tubercular patients aged between 18 and 65 years of either sex. Serum uric acid level was monitored at 0(th), 2(nd), 4(th), 6(th), and 8(th) week of ATT. Patients whose uric acid level was found to be increased at 2(nd) week were finally recruited in the study. Ninety patients who developed hyperuricemia due to ATT were divided randomly into three groups (Group A - febuxostat, Group B - allopurinol, and Group C - control) of thirty patients each. Mean serum uric acid levels were calculated at all the weeks in all the groups, and serum uric acid levels were compared by applying student's t-test and ANOVA. RESULTS: Mean serum uric acid level decreased from 10.698 mg/dl (at 2(nd) week) to 7.846 mg/dl (at 8(th) week) in Group A and from 11.34 mg/dl (at 2(nd) week) to 7.280 mg/dl (at 8(th) week) in Group B. Numbers of adverse events encountered across both the treatment groups were same with both the drugs. CONCLUSION: Allopurinol and febuxostat were equally efficacious in lowering PZA induced raised serum uric acid level in tubercular patients, and it was possible to continue ATT without withdrawing PZA.