Nonfatal CV outcomes similar between allopurinol and febuxostat treatment for gout
In the treatment of gout, the risk of nonfatal cardiovascular (CV) events, including myocardial infarction (MI) and stroke, does not significantly differ between allopurinol and febuxostat, a study has shown.
The study population comprised gout patients from Korea: 39,640 allopurinol initiators and 9,910 propensity score-matched febuxostat initiators. The mean age was 59.1 years, and 78.4 percent were male.
A composite CV event of MI, stroke/transient ischaemic attack or coronary revascularization was the primary outcome. Its incidence rate was 1.89 per 100 person-years in the allopurinol group vs 1.84 per 100 person-years in the febuxostat group (hazard ratio [HR], 1.09, 95 percent CI, 0.90–1.32).
Secondary outcomes included the individual components of the primary outcome and all-cause mortality. There was no significant difference observed between the two treatment groups (HR for all-cause mortality, 0.96, 0.79–1.16).
Results were similar in subgroup analyses limited to patients at high CV risk and to equipotent-dose initiators (ie, allopurinol ≥300 mg/day vs febuxostat ≥40 mg/day).
The findings replicate the recent US Medicare population study, researchers said. However, the current study represents a much younger population of Asians with a much lower prevalence of underlying CV conditions and risk factors than Medicare patients. [Circulation 2019;138:1116-1126]
Therefore, the present data contribute to the generalizability of the comparable CV risk between allopurinol and febuxostat, they added.