Febuxostat appears to be safe in patients with gout and fatty liver disease (FLD), but the presence of diabetes and colchicine use may increase the risk of hepatotoxicity, suggests a new study.

Thirty-two (23.9 percent) of 134 patients with gout and FLD received febuxostat, while 102 (76.1 percent) received allopurinol.

No significant between-group differences were observed in age, body mass index, comorbidity or disease severity, but patients in the febuxostat group (3/32; 9.4 percent) had a significantly lower incidence of hepatotoxicity than those in the allopurinol group (36/102; 35.3 percent; p=0.005).

Furthermore, diabetes (hazard ratio [HR], 3.549; 95 percent CI, 1.374–9.165; p=0.009) and colchicine use (HR, 11.518; 5.515–24.054; p<0.001) correlated with a greater risk of hepatotoxicity. On the other hand, febuxostat use correlated with a reduced risk of hepatotoxicity (HR, 0.282; 0.086–0.926; p=0.037).

A previous cohort study found that patients receiving allopurinol, febuxostat or colchicine for gout had hyperuricaemia and multiple comorbidities, with febuxostat initiators experiencing more comorbidities and having greater use of healthcare resources and gout-related drugs than the other groups. [Arthritis Care Res (Hoboken) 2013;65:2008-2014]

The current study included gout patients treated with febuxostat or allopurinol who were diagnosed with FLD based on ultrasonography or computed tomography.

Hepatotoxicity was defined as elevation of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) at least three times the upper limit of normal, when the baseline AST/ALT was normal, or doubling of the baseline AST/ALT, when the baseline AST/ALT was elevated. Cox regression analysis was performed to assess factors associated with hepatotoxicity.