Effect of Febuxostat on Joint Damage in Hyperuricemic Subjects With Early Gout

Inclusion Criteria:

• The participant, or the participant's legally acceptable representative, signs a written informed consent form/Health Insurance Portability & Accountability Act (HIPAA) Authorization prior to the initiation of any study procedures.

• Must have a history or presence of gout defined as having one or more of the following conditions of the American Rheumatism Association (ARA) preliminary criteria for the diagnosis of gout

  • A tophus proven to contain urate crystals by chemical or polarized light microscopic means and/or
  • Characteristic urate crystals in the joint fluid and/or

  • History of at least 6 of the following clinical, laboratory and x-ray phenomena*: *More than one flare criteria will be excluded for the purpose of this study if the participant has a history of only a single acute gout flare.

    • More than one attack of acute arthritis*
    • maximum inflammation developed within 1 day
    • monoarticular arthritis
    • redness observed over joints
    • first metatarsophalangeal joint painful or swollen
    • unilateral first metatarsophalangeal joint attack
    • unilateral tarsal joint attack
    • tophus (proven or suspected)
    • hyperuricemia
    • asymmetric swelling within a joint on x-ray
    • sub-cortical cysts without erosions on x-ray
    • joint fluid culture negative for organisms during attacks
  • *More than one flare criteria will be excluded for the purpose of this study if the participant has a history of only a single acute gout flare.

• Is male and at least 18 years of age OR;

  • Female ≥45 years of age and at least 2 years post-menopausal AND has a Follicle Stimulating Hormone (FSH) level ≥40 IU/L OR
  • Female receiving hormone replacement therapy (HRT) must be ≥55 years of age (FSH level not required).
• Has hyperuricemia defined as serum Uric Acid (sUA) level ≥7.0 mg/dL at Screening.
• Has a history of ≤2 (1 or 2) flares. In participants with a history of 2 flares, must have had only one flare in any 12 month period. The primary affected joint will be based on the location of the first gout flare which must be located within right or left metatarsophalangeal (MTP), interphalangeal (IP), ankle, metacarpophalangeal (MCP), Proximal Inter-Phalangeal (PIP), or distal inter-phalangeal (DIP) joints prior to Screening.
• Is capable of understanding and complying with protocol requirements, including scheduled clinic procedures.

Exclusion Criteria:

• Previously on urate-lowering therapy (allopurinol, febuxostat or probenecid).
• Has secondary hyperuricemia (eg due to myeloproliferative disorder or organ transplant).
• Has a history of xanthinuria.
• Has a known hypersensitivity to any component of the febuxostat formulation.
• Has rheumatoid arthritis.
• Has active peptic ulcer disease.
• Has a history of cancer, except basal cell carcinoma of the skin, which has not been in remission for at least 5 years prior to the first dose of study medication.
• Has experienced either a myocardial infarction (MI) or stroke within 90 days prior to the Screening visit.
• Has alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) values greater than 2.0 the upper limit of normal during the Screening period.
• Has a significant medical condition and/or conditions that would interfere with the treatment, safety or compliance with the protocol at the discretion of the Investigator.
• Has a history of drug abuse (defined as any illicit drug use) or a history of alcohol abuse with 5 years prior to the Screening visit. Participant consumes >14 alcoholic beverages/week.
• Has received any investigational medicinal product within 30 days prior to the Screening visit. In addition, the participant has been previously randomized into this study and received at least one dose of double blind study drug treatment.
• Has an estimated Glomerular filtration rate (eGFR) <60 mL/min calculated using the Modification of Diet in Renal Disease (MDRD) formula by the Central Laboratory.
• Has a serum creatinine at Screening greater than 2.0 mg/dL.
• Has a known history of infection with hepatitis B, hepatitis C or human immunodeficiency virus.
• Is a study site employee, or is an immediate family member (ie, spouse, parent, child, and sibling) of a study site employee involved in conduct of this study.
• Is unable to understand verbal or written English or any other language for which a certified translation of the approved informed consent form is available.
• Is required to take excluded medications.

• Magnetic Resolution Imaging:

  • Has a known hypersensitivity to gadolinium
  • Has history of severe asthma
  • Has an electronically, magnetically or mechanically activated implanted device
  • Has any object that could present a potential hazard or interfere with MRI interpretation secondary to the artifact (i.e. metallic foreign bodies)
  • Has a significant medical condition considered by the Investigator (or radiologist) to interfere with the participant's ability to receive gadolinium (eg Sickle cell anemia).