J Rheum Dis 2020; 27(2): 78-87  
What is the Best Choice for Urate-lowering Therapy for Korean?
Yun-Hong Cheon, M.D., Ph.D.1, Jung Soo Song, M.D., Ph.D.2
1Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, 2Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea
Correspondence to: Jung Soo Song http://orcid.org/0000-0001-8651-5125
Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea.
E-mail:drsong@cau.ac.kr
Received: February 25, 2020; Revised: March 8, 2020; Accepted: March 9, 2020; Published online: April 1, 2020.
© Korean College of Rheumatology. All rights reserved.

This is a open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Gout is one of the most common forms of acute inflammatory arthritis caused by long-standing hyperuricemia. Various clinical and epidemiological studies have demonstrated that uric acid, which is strongly associated with the pathogenesis of gout, is closely related with increased cardiovascular (CV) risk. Thus, properly controlling uric acid levels within its physiological level using urate-lowering therapy has been hypothesized to improve CV outcomes. Recently, however, on the basis of the results of the largest prospective, the double-blind, randomized controlled trial, entitled “the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES),” has aroused the possibility of increased CV-related and all-cause mortality in patients receiving febuxostat. Largely on the basis of this unpredicted result, the US and Korea Food and Drug Administration issued a public safety alert concerning the high risk of CV death with the use of febuxostat in February 2019. This unexpected announcement left many rheumatologists confused when they decide the first-line urate-lowering drug in Korea. In this review, we searched for previous studies on uric acid and increased risk of CV disease. In addition, we will introduce various interpretations of the results of the CARES trial and discuss the best choice of urate-lowering therapy for Korean.
Keywords: Gout, Hyperuricemia, Febuxostat, Allopurinol, Cardiovascular disease


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