Overview

The primary purpose of this study is to compare the efficacy of Tigulixostat (IBI128) versus Febuxostat on the proportion of Chinese adults with gout achieving a serum uric acid (sUA) level \< 360 μmol/L at Week 24. The study also evaluates safety, gout attacks, kidney function, inflammation, and quality of life over 52 weeks of treatment. Approximately 600 eligible participants will be randomized to receive either Tigulixostat or Febuxostat.

Eligibility

Inclusion Criteria

Participants must meet all of the following criteria to be eligible for the study:

1. Age ≥ 18 years, male or female.
2. Body mass index (BMI) between 18 and 40 kg/m².
3. Diagnosed with gout according to the 2015 ACR/EULAR classification criteria.
4. Serum uric acid (sUA) at screening:

   ≥ 480 μmol/L for subjects without comorbidities;

   ≥ 420 μmol/L for subjects with at least one concurrent condition (e.g., ≥ 2 gout attacks/year, tophi, chronic gouty arthritis, hypertension, diabetes, dyslipidemia, age of onset \< 40 years).

5. Voluntarily sign the informed consent form and agree to strictly follow the protocol requirements.

Exclusion Criteria

Participants who meet any of the following criteria will be excluded from the study:

1. History of allergy or intolerance to any component of febuxostat or Tigulixostat, or previous evidence of poor response to febuxostat treatment (e.g., sUA \> 420 μmol/L after ≥ 6 weeks of febuxostat ≥ 40 mg).
2. Acute gout attack within 4 weeks prior to screening or from screening to first dose.
3. Use of uric acid-lowering drugs (e.g., allopurinol, febuxostat, probenecid, benzbromarone, dotinurad, recombinant uricase; excluding sodium bicarbonate) within 2 weeks before screening.
4. Hyperuricemia caused by secondary gout (e.g., myeloproliferative disease, tumor, organ transplantation, enzyme deficiency, renal tubular dysfunction, lead poisoning, psoriasis, medications), excluding hyperuricemia due to renal insufficiency.
5. Use of the following medications or therapies prior to screening or planned during the study:

(1)Prior urate oxidase treatment; (2)Concomitant medications affecting uric acid levels within 4 weeks before screening with dose adjustments (e.g., losartan, calcium channel blockers, diuretics, fenofibrate, atorvastatin, α-glucosidase inhibitors, insulin sensitizers, DPP4 inhibitors, SGLT2 inhibitors, metformin, GLP-1 receptor agonists, pyrazinamide, aspirin); (3)Long-term drugs dependent on xanthine oxidase metabolism (e.g., azathioprine, mercaptopurine); (4)Oral corticosteroids ≥ 10 consecutive days, or intramuscular/intravenous/intra-articular corticosteroid injection within 4 weeks before screening; (5)Biologics (e.g., TNF-α inhibitors, IL-1 inhibitors, IL-6 inhibitors) within 12 weeks before screening.

6\. History or evidence of any of the following diseases:

1. Xanthinuria, Lech-Nyhan syndrome, 5-phosphoribosyl-1-pyrophosphate synthetase superactivity, congenital myogenic hyperuricemia, rhabdomyolysis;
2. Uncontrolled severe pain not caused by gout;
3. Cardiovascular events or conditions within 6 months (e.g., acute MI, ACS, unstable angina, CABG, PCI, TIA, cerebrovascular accident, severe arrhythmia, NYHA class III/IV heart failure);
4. QTcF ≥ 480 ms or history of prolonged QTc interval;
5. Poorly controlled hypertension (SBP ≥ 160 mmHg or DBP ≥ 100 mmHg) or recent adjustment of antihypertensive drugs;
6. Poorly controlled diabetes (HbA1c ≥ 9.0%);
7. Autoimmune or inflammatory diseases requiring systemic immunosuppressive treatment;
8. Active peptic ulcer or GI bleeding within 1 month;
9. Diseases affecting drug absorption (e.g., IBS, IBD);
10. Active hepatitis B, C, HIV, or syphilis infection;
11. Active or untreated malignancy within 5 years, except specified low-risk cancers;
12. Thyroid dysfunction requiring treatment. 7. Laboratory abnormalities:

(1)total bilirubin \> 2×ULN, ALT or AST \> 3×ULN; (2)eGFR \< 30 mL/min/1.73 m². 8. Pregnant or lactating women, or participants unwilling to use effective contraception during the study and for 8 weeks after study end.

9\. History of alcohol or drug abuse (weekly alcohol \> 21 units for males, \> 14 units for females).

10\. Blood donation or loss ≥ 400 mL within 3 months, or prior blood transfusion.

11\. Participation in another interventional clinical trial within 3 months or 5 half-lives of prior investigational drug.

12\. Major surgery within 3 months, incomplete recovery, or planned major surgery during study.

13\. Presence of mental illness deemed inappropriate for study participation by the investigator.

14\. Any other condition judged by the investigator to potentially affect study efficacy or safety evaluation.