***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Febuxostat , a novel nonpurine selective inhibitor of xanthine oxidase , is a potential alternative to allopurinol for patients with hyperuricemia and gout . METHODS We r and omly assigned 762 patients with gout and with serum urate concentrations of at least 8.0 mg per deciliter ( 480 micromol per liter ) to receive either febuxostat ( 80 mg or 120 mg ) or allopurinol ( 300 mg ) once daily for 52 weeks ; 760 received the study drug . Prophylaxis against gout flares with naproxen or colchicine was provided during weeks 1 through 8 . The primary end point was a serum urate concentration of less than 6.0 mg per deciliter ( 360 micromol per liter ) at the last three monthly measurements . The secondary end points included reduction in the incidence of gout flares and in tophus area . RESULTS The primary end point was reached in 53 percent of patients receiving 80 mg of febuxostat , 62 percent of those receiving 120 mg of febuxostat , and 21 percent of those receiving allopurinol ( P<0.001 for the comparison of each febuxostat group with the allopurinol group ) . Although the incidence of gout flares diminished with continued treatment , the overall incidence during weeks 9 through 52 was similar in all groups : 64 percent of patients receiving 80 mg of febuxostat , 70 percent of those receiving 120 mg of febuxostat , and 64 percent of those receiving allopurinol ( P=0.99 for 80 mg of febuxostat vs. allopurinol ; P=0.23 for 120 mg of febuxostat vs. allopurinol ) . The median reduction in tophus area was 83 percent in patients receiving 80 mg of febuxostat and 66 percent in those receiving 120 mg of febuxostat , as compared with 50 percent in those receiving allopurinol ( P=0.08 for 80 mg of febuxostat vs. allopurinol ; P=0.16 for 120 mg of febuxostat vs. allopurinol ) . More patients in the high-dose febuxostat group than in the allopurinol group ( P=0.003 ) or the low-dose febuxostat group discontinued the study . Four of the 507 patients in the two febuxostat groups ( 0.8 percent ) and none of the 253 patients in the allopurinol group died ; all deaths were from causes that the investigators ( while still blinded to treatment ) judged to be unrelated to the study drugs ( P=0.31 for the comparison between the combined febuxostat groups and the allopurinol group ) . CONCLUSIONS Febuxostat , at a daily dose of 80 mg or 120 mg , was more effective than allopurinol at the commonly used fixed daily dose of 300 mg in lowering serum urate . Similar reductions in gout flares and tophus area occurred in all treatment groups Objectives : To investigate the efficacy and tolerability of allopurinol as the first-choice antihyperuricaemic treatment for gout , and compare the efficacy and tolerability of benzbromarone and probenecid as second-choice treatment . Methods : Prospect i ve , multicentre , open-label , two-stage r and omised controlled trial in gout patients with normal renal function . Enrolled patients were given 300 mg allopurinol for 2 months ( stage 1 ) . Those patients who could not tolerate allopurinol or who did not attain the target serum urate concentration ( sUr ) ⩽0.30 mmol/l ( 5.0 mg/dl ) , which was defined as successful , were r and omised to benzbromarone 200 mg/day or probenecid 2 g/day for another 2 months ( stage 2 ) . Results : 96 patients were enrolled in stage 1 . 82 patients ( 85 % ) were eligible for the analysis at the end of stage 1 : there was a mean ( SD ) decrease in sUr concentration of 35 (11)% from baseline ; 20 patients ( 24 % ) attained target sUr ⩽0.30 mmol/l ; and 9 patients ( 11 % ) stopped allopurinol because of adverse drug reactions . 62 patients were enrolled in stage 2 . 27 patients received benzbromarone ( 3 patients not eligible for analysis ) and 35 received probenecid ( 4 patients not eligible for analysis ) . Treatment with benzbromarone was successful in 22/24 patients ( 92 % ) and with probenecid in 20/31 patients ( 65 % ) ( p = 0.03 compared with benzbromarone ) . Compared with baseline values , there was a mean ( SD ) decrease of sUr concentration of 64 (9)% with benzbromarone and 50 (7)% with probenecid ( p<0.001 ) . Conclusion : This study showed that allopurinol 300 mg/day has a poor efficacy and tolerability profile when used to attain a biochemical predefined target level of sUr ⩽0.30 mmol/l , following 2 months of treatment . In stage 2 , benzbromarone 200 mg/day was more effective and better tolerated than probenecid 2 g/day . Trial registration number : IS RCT N21473387 Fifty-nine patients with primary gout were treated with either a combination of colchicine and allopurinol or colchicine alone . Assessment s of renal function over 2 years revealed a statistically significant fall of glomerular filtration rate an urine concentrating ability in those receiving only colchicine . The renal function of patients given allopurinol did not change . Treatment with allopurinol result ed ina significant reduction of ammonium excretion , a phenomenon which could not be readily explained . Urate clearance also declined during allopurinol treatment , and the impaired urate clearance associated with gout became more evident . The most important observation was that allopurinol retarded an apparent decline of renal function . Presumably this was achieved through its hypouricaemic effect and implies that the hyperuricaemia of gouty patients is deleterious to the kidneys Introduction The purpose of this study was to compare urate-lowering ( UL ) efficacy and safety of daily febuxostat and allopurinol in subjects with gout and serum urate ( sUA ) ≥ 8.0 mg/dL in a six-month trial . Methods Subjects ( n = 2,269 ) were r and omized to febuxostat 40 mg or 80 mg , or allopurinol 300 mg ( 200 mg in moderate renal impairment ) . Endpoints included the proportion of all subjects with sUA < 6.0 mg/dL and the proportion of subjects with mild/moderate renal impairment and sUA < 6.0 mg/dL. Safety assessment s included blinded adjudication of each cardiovascular ( CV ) adverse event ( AE ) and death . Results Comorbidities included : renal impairment ( 65 % ) ; obesity ( 64 % ) ; hyperlipidemia ( 42 % ) ; and hypertension ( 53 % ) . In febuxostat 40 mg , febuxostat 80 mg , and allopurinol groups , primary endpoint was achieved in 45 % , 67 % , and 42 % , respectively . Febuxostat 40 mg UL was statistically non-inferior to allopurinol , but febuxostat 80 mg was superior to both ( P < 0.001 ) . Achievement of target sUA in subjects with renal impairment was also superior with febuxostat 80 mg ( 72 % ; P < 0.001 ) compared with febuxostat 40 mg ( 50 % ) or allopurinol ( 42 % ) , but febuxostat 40 mg showed greater efficacy than allopurinol ( P = 0.021 ) . Rates of AEs did not differ across treatment groups . Adjudicated ( APTC ) CV event rates were 0.0 % for febuxostat 40 mg and 0.4 % for both febuxostat 80 mg and allopurinol . One death occurred in each febuxostat group and three in the allopurinol group . Conclusions Urate-lowering efficacy  of febuxostat 80 mg exceeded that of febuxostat 40 mg and allopurinol ( 300/200 mg ) , which were comparable . In subjects with mild/moderate renal impairment , both febuxostat doses were more efficacious than allopurinol and equally safe . At the doses tested , safety of febuxostat and allopurinol was comparable . Clinical Trial Registration This study was aim ed to evaluate the efficacy of benzbromarone compared to allopurinol in lowering serum uric acid level in hyperuricemic patients with normal renal function ( serum creatinine < or = 1.5 ) . The authors conducted a crossover study consisting of two four-week treatment periods of allopurinol 300 mg/day and benzbromarone 100 mg/day separated by a four-week washout period . Fourteen patients with mean age and duration of hyperuricemia of 60.78 + /- 8.62 and 6.93 + /- 3.69 years , respectively , were recruited and all completed our study protocol . This study was a crossover design consisting of two four-week treatments of allopurinol and benzbromarone separated by a four-week washout period . The serum uric acid level was reduced from 9.89 + /- 1.43 mg/dl to 5.52 + /- 0.83 mg/dl and from 9.53 + /- 1.48 to 4.05 + /- 0.87 mg/dl by allopurinol and benzbromarone , respectively . The efficacy of benzbromarone in lowering serum uric acid level was significantly superior to allopurinol ( p=0.005 ) . No patient reported clinical side effects during treatment with either drug . In conclusion , the authors have shown that benzbromarone is more effective than allopurinol in the reduction of serum uric acid levels in hyperuricemic patients with normal renal function OBJECTIVE To observe the clinical effect of a modified Simiao Tang ( Modified Decoction of Four Wonderful Drugs ) for gouty arthritis and its influence on uric acid in blood . METHODS 120 cases of gouty arthritis were r and omly divided into the treatment group and control group with 60 cases in each group . Modified Simiao Tang ( MST ) was orally administered to the patients in the treatment group and allopurinol tablet was orally administered to the patients in the control group . The clinical effects of two groups were evaluated after one-week treatment and uric acid ( UA ) and C-reactive protein ( CRP ) levels in blood were determined after 1-month treatment . RESULTS The total effective rate in the treatment group was significantly higher than in the control group , 86.7 % vs. 68.3 % ( P < 0.01 ) . And the treatment group was also significantly better than the control group in decreasing UA and CRP ( P < 0.05 or P < 0.01 ) . CONCLUSIONS MST can significantly improve the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP . It is good for gouty arthritis Objectives : To compare the efficacy and tolerability of allopurinol 300–600 mg/day versus benzbromarone 100–200 mg/day used to attain a target serum urate concentration ( sUr ) ⩽0.30 mmol/l ( 5 mg/dl ) . Methods : A r and omised , controlled , open-label , multicentre trial in gout patients with renal function defined as a calculated creatinine clearance ⩾50 ml/min . Patients were treated with 300 mg allopurinol or 100 mg benzbromarone once a day ( stage 1 ) . If sUr ⩽0.30 mmol/l was not attained after 2 months , the dose was doubled to allopurinol 300 mg twice a day or benzbromarone 200 mg once a day ( stage 2 ) . The primary end point was treatment success in either of the two stages , defined as clinical tolerability and attainment of biochemical target sUr . Results : Sixty-five patients were enrolled in stage 1 ; 36 received allopurinol and 29 received benzbromarone .  Fifty-five patients ( 85 % ) were analysed at stage 1 : the success rates were 8/31 ( 26 % ) and 13/25 ( 52 % ) , respectively , and the difference was −0.26 ( 95 % CI from −0.486 to −0.005 ) , p = 0.049 . At stage 2 , the success rates were 21/27 ( 78 % ) and 18/23 ( 78 % ) , respectively , and the difference was −0.005 
    Output:
    
They did not report tophi regression , pain and function .
There was moderate- quality evidence of little or no difference in the proportion of participants achieving target serum urate when allopurinol was compared with benzbromarone .