Immediate Prescription of a Hypouricemic Treatment, Febuxostat, Compared to Its Delayed Administration

Summary

Gout, the most common inflammatory rheumatism in France, is a complication of chronic hyperuricemia (\> 360umol / l). The resulting urate crystals are deposited in many tissues, especially the skeletal or kidneys. It appears in the form of spontaneously regressive inflammatory joint attacks in 5 to 7 days but recurrent. Gout turns into a chronic disease if uric acidemia is not reduced, and is responsible for joint destruction. It becomes a vector of renal failure and is associated with cardiovascular morbidity and a reduction in life expectancy. It is cured if a long-term treatment such as febuxostat leading to the normalization of the uric acidemia is administered. However, the frequency of this disease is increasing in industrialized or emerging countries. The causes are numerous, particularly food, but also related to flaws in therapeutic care. Studies show that this treatment is not taken in particular because, after the acute attack, the patient who has become asymptomatic again no longer consults. Currently, in a traditional way and according to European recommendations, it is not prescribed until several weeks after the acute attack in order to avoid early relapses, which would then be more numerous. Nevertheless, even if the hypouricemic agent is prescribed late , the attacks can be repeated and become rare for several months after obtaining a uricemia below 360umol / l; they eventually disappear. Lack of knowledge of this disease largely affects the hazards of disease-modifying treatment, which alone can prevent the progression to chronic inflammatory disease and its cardiovascular and renal impact and on mortality. One of the causes of not taking a hypouricemic agent is its delayed administration. This study is proposed to assess the relevance of early initiation versus delayed administration of such treatment.

Eligibility

Inclusion Criteria:

1. Patients with an attack of gout, diagnosed immediately or less than 5 days old. Gout is defined according to American-European criteria (Appendix 3).
2. Attack of gout affecting one (or more) peripheral joint (s) whatever (s) it (s):

   * Either a first crisis,
   * Either a new attack of a gout not treated with a hypo-uricemic or for which the hypo-uricemic treatment has not been taken for at least 6 months.
3. Uricemia ≥ 420 µmol / l, including under a diuretic (dosage carried out within 10 days before inclusion),
4. Age ≥ 18 years old,
5. Patient with a creatinine clearance ≥ 30 ml / min (dosage carried out within 10 days before inclusion),
6. Patient having read and understood the information letter and signed the consent form,
7. Affiliation to a social security scheme,
8. Woman of childbearing potential with effective contraception according to WHO definition (estrogen-progestins or intrauterine device or tubal ligation for more than 1 month and to be continued for at least 5 weeks after the last dose of the drug. ) and a negative urine pregnancy test on inclusion and throughout the duration of the study Where Postmenopausal woman: amenorrhea not medically induced for at least 12 months before the inclusion visit.

Exclusion Criteria:

1. Patients under the age of 18,
2. Stop taking a hypouricemic agent for less than 6 months,
3. Known contraindication to ADENURIC 80 mg film-coated tablet: hypersensitivity to the active substance (febuxostat) or to one of the excipients,
4. Renal failure defined by creatinine clearance \<30 ml / min,
5. Hepatic disease defined by an increase to more than 2 times the normal of transaminases, alkaline phosphatases, to more than 3 times the normal of gamma-GT,
6. Non-weaned alcoholism,
7. Crisis more than 5 days old,
8. Patient who has received an organ or marrow transplant,
9. Person on Naproxen, mercaptopurine, azathioprine, Glycuronidation inhibitors and inducers, theophylline, macrolides, HMG Co-A reductase inhibitors and / or diuretic in combination with an ACE inhibitor or ARAII,
10. Person with rare hereditary disorders of galactose intolerance, lactase deficiency or glucose / galactose malabsorption
11. Poor understanding of the project due to neurological disease or lack of French practice,
12. Pregnant woman or likely to be in the absence of effective contraception (Women of childbearing age should have a negative urine pregnancy test),
13. Breastfeeding woman
14. Any history of pre-existing major cardiovascular disease (myocardial infarction, stroke, unstable angina, etc.), metabolic, endocrine, psychiatric or cancerous in uncontrolled development,
15. Person deprived of liberty by an administrative or judicial decision,
16. Person placed under judicial protection, guardianship or curatorship,
17. Participating patient who participated in the month preceding inclusion in another interventional drug trial.

Conditions2

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