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Cutaneous adverse events with febuxostat after previous reactions to allopurinol: comment on the article by Singh and Cleveland
  1. Neus Quilis1,
  2. Paloma Vela2,
  3. Boris A Blanco Cáceres3,
  4. Cesar Diaz-Torne4,
  5. Enrique Calvo-Aranda5,
  6. Francisca Sivera6,7,
  7. Alejandro Prada-Ojeda8,
  8. Fernando Pérez Ruiz3,
  9. Eliseo Pascual9,
  10. Mariano Andrés10
  1. 1Rheumatology Unit, Hospital Universitario del Vinalopo, Elche, Alicante, Spain
  2. 2Rheumatology Department, Hospital General Universitario de Alicante, Alicante, Spain
  3. 3Rheumatology, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
  4. 4Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  5. 5Rheumatology, Hospital Universitario HM Sanchinarro, Madrid, Spain
  6. 6Medicine, Miguel Hernandez University of Elche Faculty of Medicine, Sant Joan D'Alacant, Spain
  7. 7Rheumatology, Hospital General Universitario Elda, Spain
  8. 8Rheumatology, Hospital Universitario de Torrejón, Torrejon de Ardoz, Madrid, Spain
  9. 9Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
  10. 10Rheumatology, Hospital de Alicante, Alicante, Spain
  1. Correspondence to Dr Neus Quilis, Rheumatology Unit, Hospital Universitario del Vinalopo, 03010 Alicante, Spain; neqima87{at}

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Dear Editor,

We read with interest the recent article by Singh and Cleveland on the hypersensitivity risk of allopurinol (ALP) and febuxostat (FBX) compared with colchicine.1 A common challenge when using ALP, linked to hypersensitivity reactions, is the potential development of cutaneous adverse reactions (CARs). Most are often mild, non-specific rashes; however, severe CARs, including Stevens-Johnson syndrome (SJS), may occur, but with a low incidence (0.69 cases per 1000 person-years) in non-Asian populations.2 In the EuroSCARs study, ALP was the reason for 5% of all severe CARs.3 So, FBX is often chosen as urate-lowering agent on the background of an ALP-related CAR. However, these patients were not eligible for the pivotal trials of FBX4 and were excluded from the recent analysis by Singh and Cleveland.1 Therefore, the accurate rate of FBX-related CARs in patients who previously suffered from ALP, and the mechanisms behind, remain undetermined to date.

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