The effect of intensive urate lowering therapy (ULT) with febuxostat in comparison with allopurinol on cardiovascular risk in patients with gout (short title: the FORWARD trial)

Recruitment & Eligibility

Status: ot Recruiting

Sex: All

Target Recruitment: 196

Inclusion Criteria

1. Male or female patients 18 years and older;
2. History of gout, flare free in the 4 weeks prior to study entry
3. History of crystal (joint liquid) proven diagnosis or anamnestic diagnosis of gout according to Wallace et al. To be eligible a subjects has to present at least 6 out of the twelve clinical, laboratory, and X-ray phenomena listed below:
1. Maximum inflammation developed
within 1 day
2. More than one attack of acute arthritis
3. Monoarticular arthritis attack
4. Redness observed over joints
5. First metatarsophalangeal (MTP) pain or
swelling
6. Unilateral first MTP joint attack
7. Unilateral tarsal joint attack
8. Suspected or proven tophus
9. Hyperuricemia
10. Asymmetric swelling within a joint on
a X-ray
11. Subcortical cysts without erosions on
X-ray
12. Negative organisms on culture of joint
fluid

4. Naive to ULT or previously treated with ULT, but with no ULT treatment in the last 1 month prior to study entry and only if reason for ULT interruption was not due to safety concerns.
5. Patients at study entry have elevated serum urate level> 8 mg/dl.
6. Overall CV risk based on the scoring proposed by the Joint Task Force of the European Society of Cardiology and other Societies on cardiovascular disease prevention in clinical practice between 5 and 15% (inclusive) as per protocol appendix 2. Patients with diabetes mellitus type 2 could be included in the study if their CV risk score is calculated as =7%.
7. Concomitant medications should be maintained stable during the last 2 weeks before randomization

Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 122
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 60

Exclusion Criteria

1. Severe chronic renal failure (creatinine clearance < 30 ml/min)
2. Hepatic failure
3. Active liver disease or hepatic dysfunction, defined as both ALT and AST >2 times the upper limit of normal.
4. Diabetes mellitus type1
5. Life-threatening co-morbidity or with a significant medical condition and/or conditions that would interfere with the treatment, the safety or the compliance with the protocol
6. Diagnosis of, or receiving treatment for malignancy (excluding minor skin cancer) in the previous 5 years
7. Patients who have experienced either myocardial infarction or stroke
8. Patients with inflammatory based arthritis (e.g.: rheumatoid arthritis, etc.)
9. Patients with congestive heart failure, New York Heart Association (NYHA) Class III or IV
10. Patients with untreated/uncontrolled thyroid function
11. Patients with clinically severe peripheral arterial disease
12. Concomitant administration of one of the following: azathioprine, mercaptopurine, theophylline, meclofenamate, sulfinpyrazone, trimethoprim-sulfamethoxazole, cyclophosphamide, benzbromarone, pyrazinamide, captopril and enalapril (for Allopurinol), tegafur, pegloticase and tacrolimus.
13. Hypersensitivity to any of the active substance or to any of the excipients
14. Any contraindication to febuxostat or allopurinol (with reference to the summary of product characteristics).
15. Subject is unable to take either of the protocol-required gout flare prophylactic medications (NSAID or colchicine) due to contraindications or intolerance, e.g. hypersensitivity, active gastric ulcer disease, renal impairment and/or changes in liver enzymes

Study & Design

Study Type: Interventional clinical trial of medicinal product

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method

Secondary Outcome Measures

Name	Time	Method

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