The Study
Stepwise dose increase of febuxostat is comparable with colchicine prophylaxis for the prevention of gout flares during the initial phase of urate-lowering therapy: results from FORTUNE-1, a prospective, multicentre randomised study
This study compared three ways to prevent gout flares when starting a new medicine. It randomly assigned people to different groups, which helps us guess what might cause the flares to go down. But because everyone knew which treatment they got, people might have reported flares differently. So we can't say for sure that one method causes fewer flares—only that it might.
Analysis score
Maximum 90 for a randomized controlled trial.
Where the score came from
When starting a new gout medicine, sudden drops in uric acid can trigger painful flares. This study tested two ways to prevent that: slowly increasing the medicine dose, or taking a low dose of colchicine.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 579 / 100
Quality score
Participants are randomly assigned to treatment or control groups, minimizing bias. The gold standard for testing whether an intervention causes an effect.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — cutting flare risk from 36% to under 20% means fewer painful episodes and better chance patients stick with their treatment.
- 221% of patients on slow-dose febuxostat had flares, 19% on colchicine had flares, but 36% on full-dose febuxostat alone had flares.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
Annals of the Rheumatic Diseases
Year
2017
Authors
H. Yamanaka, Shigenori Tamaki, Yumiko Ide, Hyeteko Kim, Kouich Inoue, Masayuki Sugimoto, Yuji Hidaka, A. Taniguchi, S. Fujimori, Tetsuya Yamamoto
Related Content
Claims (4)
In patients with gout and high uric acid levels, taking a fixed 40 mg daily dose of febuxostat without preventive medication or gradual dose increases results in a 36.0% rate of gout flares within 12 weeks, which is higher than the 20.8% rate with stepwise dosing and the 18.9% rate with colchicine prophylaxis.
In patients with gout and high uric acid levels, gradually increasing febuxostat from 10 mg to 40 mg per day over eight weeks results in the same reduction in gout flare frequency as taking 0.5 mg of colchicine daily, and both approaches reduce flares more than taking 40 mg of febuxostat daily from the start.
Over a 12-week period, patients with gout taking 0.5 mg of colchicine daily experience the same rate of adverse reactions as those taking either stepwise or fixed-dose febuxostat.
Starting allopurinol at a low dose along with anti-inflammatory medication lowers the chance of acute gout flares when lowering uric acid levels.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.