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We appreciate the interest and comments by Quilis et al1 on our recent publication.2 Quilis et al draw our attention to the incidence of cutaneous adverse reactions (CARs) with febuxostat in people who had already had reactions with allopurinol. In their study which included several practices in Spain from 2011 to 2018, 15% of people developed these reactions with febuxostat1 compared with the 9%–15% range reported previously for similar patient populations from the USA and France.3 4 CARs are frequent, and are associated with significant morbidity.5 Interestingly, the rate of CARs in people newly starting febuxostat and not previously …
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