Treatment: urate-lowering therapy (allopurinol, febuxostat)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Before starting
Laboratory tests
- Serum urate
- Serum creatinine with eGFR
- ASTif neededFebuxostat: the SmPC recommends liver function tests before initiation, then periodically according to clinical judgement [2]. Allopurinol: reduced doses in hepatic impairment and periodic liver function checks at the start of treatment [3].
- ALT (febuxostat; allopurinol if hepatic impairment)if neededFebuxostat: the SmPC recommends liver function tests before initiation, then periodically according to clinical judgement [2]. Allopurinol: reduced doses in hepatic impairment and periodic liver function checks at the start of treatment [3].
- HLA-B*5801 allele testing (patient of Han Chinese, Thai or Korean origin; not in the French fee schedule)if neededThe SmPC asks for screening to be considered before allopurinol in subgroups with a high prevalence of the allele (up to 20% in Han Chinese, 8-15% in Thais, about 12% in Koreans) [3]; the SFR (French Society of Rheumatology) sees value in it in patients of South Asian origin, notably with renal impairment, but the test is not reimbursed [1]. Of no value in patients of European origin [1].
Do not order
- Routine HLA-B*5801 genotyping before allopurinol in patients of European origin: the SmPC has not shown it outside Han Chinese, Thai or Korean populations [3]; the SFR considers it of no value in French Caucasians [1].
- Urate-lowering drug for asymptomatic hyperuricaemia: not an indication for allopurinol [3] and the SFR does not recommend it (the diagnosis of gout must be certain) [1]. See the pages “Asymptomatic hyperuricaemia” and “Gout”.
Twice-yearly tests
Laboratory tests
- Serum urate
Annual tests
Laboratory tests
- Serum urate
- Serum creatinine with eGFR
- ASTif neededFebuxostat: liver function tests “periodically thereafter, according to clinical judgement” (no fixed interval) [2].
- ALT (febuxostat)if neededFebuxostat: liver function tests “periodically thereafter, according to clinical judgement” (no fixed interval) [2].
- CK (renal failure treated with colchicine, especially with a statin)if neededThe SFR asks for clinical monitoring and periodic CK in patients with renal failure on colchicine, who can develop rhabdomyolysis, especially if they also take a statin [1].
Sources (9)
- Pascart T, Latourte A, Flipo RM, et al. 2020 recommendations from the French Society of Rheumatology for the management of gout: Urate-lowering therapy. Joint Bone Spine. 2020;87(5):395-404.
- Febuxostat Biogaran 80 mg, comprimé pelliculé (générique d'Adenuric). Résumé des caractéristiques du produit, rubriques 4.2 à 4.4 (base de données publique des médicaments ; mise à jour de la page le 29/09/2026).
- Zyloric 300 mg (allopurinol), comprimé. Résumé des caractéristiques du produit, rubriques 4.2 à 4.4 (base de données publique des médicaments ; mise à jour de la page le 29/09/2026).
- FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken) 2020;72(6):744-760.
- National Institute for Health and Care Excellence (NICE). Gout: diagnosis and management. NICE guideline NG219, 9 juin 2022.
- Zorginstituut Nederland. Farmacotherapeutisch Kompas : allopurinol (texte de la substance, avec la posologie de la NHG-Standaard Artritis 2017), consulté le 29 octobre 2026.
- Clebak KT, Morrison A, Croad JR. Gout: Rapid Evidence Review. Am Fam Physician. 2020;102(9):533-538.
- Haute Autorité de santé. Maladie rénale chronique de l'adulte : les points critiques du parcours (synthèse), septembre 2021.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : acte 0532 (uricémie), acte 0592 (créatininémie), complément à la cotation minimale B20 (acte 9915).