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As a rheumatologist, I often encounter patients who are suffering greatly from gout.The sudden joint pain, often occurring in the big toe, knee joints, etc., is red, swollen, hot, and painful, making it difficult to walk.It feels as if a fierce tiger is biting, hence gout was also called “White Tiger’s Joint” in ancient times.
Recently, patients often ask about two new drugs that have just hit the market, namely Dotinurad（Dotinurad）andFirsekibart（Firsekibart）.
If you ask me how these two new drugs are, the simple summary is that they are more precise, safer, longer-lasting, and suitable for a wider range of people. They can not only quickly relieve pain and prevent recurrence in the long term but also further reduce the risk of liver damage.
As for the specifics, let’s talk about it in detail today.
Gout: More Than Just “Eaten Out” Joint Pain
Many people believe that gout is simply the result of overindulging in seafood and alcohol. This is true to some extent, as a high-purine diet is indeed an important trigger, but the essence of gout is hyperuricemia. Our body metabolizes and produces uric acid, and when the concentration of uric acid in the blood is too high, urate crystals will precipitate like salt, forming small crystals that deposit in joints, skin, and even the kidneys.
These urate crystals in the joints may be harmless under normal circumstances(asymptomatic hyperuricemia phase).Once a “trigger” is encountered, such as injury, cold, or overeating, they are seen as “foreign invaders” by the immune system, immediately causing a severe inflammatory “war” – this is the acute attack of gout.
If gout is not controlled in the long term, the consequences can be severe:
Recurrent attacks:From once or twice a year to several times a month, severely affecting the quality of life.
Gouty tophi:Urate salts accumulate under the skin forming “nodules,”damaging joints and bones.
Kidney damage:Urate crystals damage the renal tubules, leading tokidney stones, chronic kidney disease, and even renal failure.
Cardiovascular involvement:Hyperuricemia is an independent risk factor for hypertension, coronary heart disease, and heart failure.
Therefore, gout treatment must “grasp with both hands, and both hands must be strong”:
One hand for anti-inflammatory treatment, to address the symptoms, and to relieve pain quickly;
One hand for reducing uric acid, to address the root cause, to prevent recurrence and complications.
Traditional drugs show significant effects,
but each has its shortcomings
Before introducing new drugs, let’s first understand the existing traditional medications.
Symptomatic treatment: anti-inflammatory during acute phase
Nonsteroidal anti-inflammatory drugs（NSAIDs）：Such as etoricoxib, celecoxib, diclofenac sodium, etc.Fast anti-inflammatory and analgesic effects, commonly used as first-line drugs. However, they may harm the stomach and affect kidney function,patients with cardiovascular diseases should use with caution.
Colchicine：A special drug for gout, the earlier it is used, the better the effect. However, the therapeutic dose is close to the toxic dose, which can easily cause gastrointestinal reactions such as diarrhea and vomiting.
Glucocorticoids：Such as prednisone, dexamethasone.Strong anti-inflammatory power, commonly used when the above drugs are ineffective or contraindicated. However, should not be used repeatedly for a long time, to avoid side effects such as increased blood sugar and osteoporosis.
The common dilemma of these traditional anti-inflammatory drugs is:
They mainly suppress the “downstream” of inflammation or act “generally,” not precisely targeting IL-1β, the “core commander.” For patients with frequent attacks, ineffective traditional drugs, or contraindications(such as poor stomach or kidney),the effect is limited, and they cannot be used for long-term prevention of recurrence.
Root treatment: reducing uric acid during remission period
✅ Uric acid production inhibitors：
Allopurinol：A classic old drug, inexpensive and effective. However,a few people(especially Han Chinese)may have severe allergic reactions, and genetic testing is recommended before taking the medication.
Febuxostat：A new potent drug with relatively less burden on the liver and kidneys. However, some recent studies suggest that for at-risk populations, its risk of cardiovascular events may be slightly higher than allopurinol,patients with cardiovascular and cerebrovascular diseases need to weigh the pros and cons.
✅ Uric acid excretion promoters：
Benzbromarone：
By inhibiting the URAT1 transporter in the kidney, it allows more uric acid to be excreted in the urine.Strong effect in reducing uric acid, especially suitable for the majority of Chinese people who are “poor uric acid excretors”. However,there is a certain risk of liver damage, and it is contraindicated in patients with liver dysfunction.
The challenge of traditional uric acid-lowering drugs is:
Allopurinol/Febuxostat may be insufficient for “poor excretors”; Benzbromarone has liability concerns, and its effectiveness decreases when kidney function is moderately impaired or worse.
Two new drugs have come to the market,
bringing new breakthroughs in treating the root and symptoms
Let’s talk about these two newly marketed drugs, are they reliable? How effective are they?
New uric acid-lowering drug: Dotinurad（Dotinurad）
Dotinurad was approved in Japan in 2020. It is a new type of selective uric acid reabsorption inhibitor（SURI）. You can think of it as a“precision upgraded version” of benzbromarone.
✅ More precise action:
It highly selectively inhibits the URAT1 protein in the kidney(the main channel for uric acid reabsorption), hardly affecting other renal or intestinal urate transporters. This means it has higher efficiency in promoting uric acid excretion, and theoretically has fewer “off-target” side effects.
✅ Comparable effectiveness:
Studies show that 2mg of Dotinurad daily is as effective as 50mg of benzbromarone in reducing uric acid, enabling over 80% of patients to achieve the target uric acid level(<6 mg/dL≈360umol/L).In another non-inferiority study,2mg of Dotinurad daily is similar in effect to 40mg of febuxostat in reducing serum uric acid levels, with no significant difference in the achievement rate.
✅ Improved safety:
Its chemical structure has been optimized toavoid the hepatotoxicity associated with benzbromarone. In clinical studies, the incidence of liver function abnormalities is similar to that of the placebo. It remains effective in patients with mild to moderate renal insufficiency, providing a new option for such patients. In addition to being compared with benzbromarone, clinical studies have also shown that its liver-related adverse reaction incidence is lower than that of febuxostat.
✅ Potential additional benefits:
Preliminary research has found that it may also have the “extra bonus” of improving vascular elasticity and reducing oxidative stress, which is good news for gout patients with hypertension and diabetes. In short, Dotinurad inherits the advantages of benzbromarone in effectively reducing uric acid, while optimizing liver safety and action precision, providing a better option for “poor uric acid excretors”.
New anti-inflammatory drug: Firsekibart（Firsekibart）
Firsekibart is the world’s first IL-1β monoclonal antibody approved in China in June 2025 for the treatment of acute gout attacks. It is a therapeutic biological agent, characterized by precise and long-lasting anti-inflammatory action.
✅ Precise target:
Unlike traditional anti-inflammatory drugs that “bombard” the body, it precisely identifies and firmly binds to IL-1β, the “core commander” that triggers gout inflammation, directly blocking its activity, extinguishing the fire of inflammation at its source.
✅ Strong and long-lasting:
Phase III clinical studies show that for patients with acute attacks that are ineffective or intolerant to traditional anti-inflammatory drugs, a single subcutaneous injection of 200mg,
the analgesic effect within 72 hours is not inferior to compound betamethasone(a potent hormone), and it can significantly reduce the risk of gout recurrence within the next 24 weeks by 87%.
✅ Convenient use:
One injection, the effect can last up to 6 months(usually only two injections are needed per year). For patients with frequent attacks and those troubled by pain, or patients who need long-term anti-inflammatory protection at the beginning of uric acid reduction treatment(easily inducing attacks), it provides a revolutionary solution.
✅ Good safety:
Due to its precise action, itssystemic side effects(such as infection risk)are much lower than long-term use of hormones, and the main adverse reaction is the reaction at the injection site, which is mostly mild.In short, Firsekibart represents the precision and long-lasting new era of gout anti-inflammatory treatment. It is particularly suitable for patients with frequent attacks, poor effects of traditional anti-inflammatory drugs, or contraindications, and can quickly relieve pain and prevent recurrence in the long term, bringing hope to “refractory gout” patients.
Collaboration towards “clinical cure”
The modern treatment concept of gout is “targeted treatment” and “long-term management”.
01 Acute phase
Quickly control inflammation and relieve pain. Choose from NSAIDs, colchicine, corticosteroids, or the new Firsekibart according to the situation.
02 Remission phase
Initiate and persist in uric acid-lowering treatment(ULT), keep the blood uric acid stably controlled below the target value(without tophi <360 μmol/L, with tophi <300 μmol/L),dissolve the formed urate crystals and prevent the formation of new crystals.
03 “Escort” at the beginning of uric acid reduction
At the beginning of uric acid reduction treatment(usually 3-6 months), since blood uric acid fluctuations can easily induce attacks, prophylactic anti-inflammatory treatment is needed at the same time. Traditionally, low-dose colchicine or NSAIDs are used. Now,long-acting and precise anti-inflammatory drugs like Firsekibart may provide a better option for these patients.
04 New drug positioning
Dotinurad：It is a new option for uric acid-lowering treatment,especially suitable for patients with poor uric acid excretion, concerns about liver damage, or mild kidney damage.
Firsekibart：It is the trump card and upgraded option for anti-inflammatory treatment,used for patients with poor effects of traditional anti-inflammatory drugs, intolerance, or those who need long-term and efficient prevention of recurrence.
Conclusion
From the classic allopurinol, febuxostat, benzbromarone, to the new Dotinurad; from traditional colchicine, NSAIDs, corticosteroids, to the precise and long-lasting Firsekibart, our drugs are becoming richer and more advanced.
The key to gout treatment is to recognize the nature of the disease and follow standardized treatment. Under the guidance of a doctor, develop a combined “anti-inflammatory + uric acid reduction” plan, persist in long-term management, and monitor uric acid and liver and kidney functions. There is every hope of saying goodbye to recurrent severe pain, dissolving tophi, protecting the heart and kidneys, and enjoying a pain-free life.
Peer review expert
Guo Xiao
Distinct Internal Medicine Physician, Ph.D. from Peking Union Medical College
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