Fenofibrate in addition to xanthine oxidase inhibitors lowers uric acid level in patients with gout
Adding fenofibrate to allopurinol or febuxostat reduces uric acid levels in patients with gout without showing any significant change in renal or hepatic functions, a recent study has shown. This suggests that cotreatment of fenofibrate with xanthine oxidase inhibitors is a reasonable option for treating gout in patients who have high triglyceride levels.
Of the patients, 70 (8.11 percent) took fenofibrate together with allopurinol or febuxostat, with male and young patients taking the study drug more frequently. Individuals administered the combination treatment were less likely to have hypertension than those administered only xanthine oxidase inhibitors. [Sci Rep 2018;8:16767]
Serum uric acid levels were significantly lower after the treatment in patients administered fenofibrate cotreatment than in those who took allopurinol or febuxostat alone (−1.81±2.41 vs −2.40±2.28 mg/dL; p=0.043). Uric acid reduction had a greater effect on patients taking glucocorticoids vs other treatments (b, –1.098; p<0.001).
Furthermore, no difference was observed in the levels of creatinine, blood urea nitrogen and aminotransferases between patients treated with and without fenofibrate.
Previous studies have shown that fenofibrate treatment in patients with gout taking urate-lowering agents decreased uric acid levels by 19 percent and 23 percent. [Rheumatology 2003;42:321-325; Korean J Intern Med 2006;21:89-93]
“However, although the reduction of urate levels was assessed in a small number (10 and 14) of patients with gout, this study collected sufficient clinical data to evaluate the general effect of fenofibrate. Furthermore, in the previous studies, patients treated with only allopurinol were enrolled, whereas our patients were prescribed allopurinol or febuxostat,” researchers said.
Of the two xanthine oxidase inhibitors, febuxostat is considered more effective in achieving target uric acid levels. [Sci Rep 2016;6:33082; Int J Rheum Dis 2014;17:679-686]
“Fenofibrate decreases serum uric acid levels by increasing urinary excretion of uric acid by inhibiting the renal organic anion transporter urate transporter. Moreover, it was shown to raise urinary pH, and acidic urinary pH could be associated with the formation of uric acid stones, which is one of the comorbidities of gout and a common complication of uricosuric agents,” researchers explained. [Intern Med 2010;49:89-94; Horm Metab Res 2007;39:511-514; Pharmacol Res 2015;102:63-70]
Therefore, adding fenofibrate is a reasonable option for treating patients with gout, considering that agents that increase the renal excretion of uric acid are likely to result in the development of uric acid stones, they added.
The present study examined the effect of uric acid reduction by fenofibrate in patients with gout administered xanthine oxidase inhibitors allopurinol or febuxostat. Researchers collected data from 863 patients with gout from electronic medical records comprising information on underlying diseases, laboratory findings and drug histories.
“Gout is a chronic disease associated with deposition of monosodium urate crystals and accompanied by diabetes, hypertension and dyslipidaemia. Hypertriglyceridaemia is common among patients with gout, and fenofibrate is usually used to reduce triglyceride levels,” researchers said.