American Board of Internal Medicine (ABIM) Certification Practice Exam

Febuxostat's primary advantage over allopurinol is that it is less likely to cause which type of reaction?

1. Gastrointestinal

2. Hypersensitivity

3. Cardiovascular

4. Neurological

The correct answer is: Hypersensitivity

Febuxostat is primarily effective as a xanthine oxidase inhibitor used in the management of hyperuricemia associated with gout. One of its key advantages over allopurinol is its reduced incidence of hypersensitivity reactions. Hypersensitivity to allopurinol can present in various forms, including severe cutaneous adverse reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as other types of allergic reactions. These reactions can occur more frequently in certain patient populations, particularly those with renal impairment or a history of hypersensitivity to medications. In contrast, febuxostat is associated with a significantly lower risk of these types of hypersensitivity reactions. This characteristic makes it a preferred option for patients who may be at risk for such complications or who have had intolerable side effects with allopurinol. Understanding this difference is crucial in clinical practice, especially when selecting a urate-lowering therapy for patients with gout, particularly in those who have previously demonstrated hypersensitivity to allopurinol. This differentiation in patient safety and tolerability is an important aspect of treatment decision-making in gout management.