Febuxostat bests allopurinol, benzbromarone in lowering cholesterol, triglycerides in gout patients
Uric acid (UA)-lowering therapy (UALT) for gout also confers benefits for hyperlipidaemia, with febuxostat delivering greater reductions in cholesterol and triglyceride concentrations in the blood as compared with allopurinol and benzbromarone, according to a recent study.
The findings show that UALTs, aside from effectively lowering UA levels, can control hypercholesterolaemia and hypertriglyceridaemia in patients with gout, the investigators said. “We suggest that doctors … consider the economic status of patients and accordingly select the appropriate therapy.”
The analysis included 124 gout patients with hypercholesterolaemia (87.10 percent of the population) or hypertriglyceridaemia (40.32 percent) who were administered UALT. Of these, 52 received febuxostat (40 mg/d), 29 received allopurinol (300 mg/d), and 43 received benzbromarone (50 mg/day). There was no correlation between hypertriglyceridemia and gout (p=0.397).
Following 7–9 weeks of treatment, UA levels improved across the three treatment arms (p<0.05), with the greatest effects seen between weeks 3 and 5. Specifically, UA decreased from 9.72 mg/dl at baseline to 7.2 mg/dl at weeks 3–5 (vs baseline: p=0.0001) and 7.02 mg/dl at weeks 7–9 (vs weeks 3–5: p=0.714) with febuxostat; from 9.69 to 8.12 mg/dl (p=0.018) and 7.55 mg/dl (p=0.378), respectively, with allopurinol; and from 9.97 to 7.96 mg/dl (p=0.0007) and 7.50 mg/dl (p=0.449), respectively, with benzbromarone. [Int J Rheum Dis 2019;doi:10.1111/1756-185X.13652]
Results for hypercholesterolaemia and hypertriglyceridaemia followed a similar pattern. At weeks 3–5, serum cholesterol and triglyceride concentrations declined by 55.1 and 96.7 mg/dl, respectively, with febuxostat (vs baseline: p=0.0001 for both), 39.5 and 100.3 mg/dl with allopurinol (vs baseline: p=0.0001 and p=0.013, respectively), and 25.5 and 57.0 mg/dl with benzbromarone (vs baseline: p=0.0013 and p=0.014, respectively).
“Upon comparison of the allopurinol and benzbromarone groups, the febuxostat group showed an enhanced ability to downregulate cholesterol and triglycerides. [F]urther analysis [revealed that] only febuxostat can decrease [both parameters] in patients not receiving lipid‐lowering therapy,” the investigators noted.
Hypercholesterolaemia and hypertriglyceridaemia are believed to be problematic for both patients and doctors, especially considering the risk of metabolic syndrome and the subsequent increased risk of cardiovascular and cerebrovascular diseases.
“If febuxostat improves hypercholesterolaemia and hypertriglyceridaemia, gout patients would experience economic benefits, since statins and fenofibrate are costly therapies. [The said UALT] may represent an economically favourable therapy for those with lipid disorders,” they added.