Febuxostat Versus Allopurinol Use in Gout Patients: A Real-World Study

TL;DR

This real-world study compares febuxostat and allopurinol in gout patients, finding no significant difference in cardiovascular events or deaths after adjusting for risk factors.

Contribution

The study provides real-world evidence on cardiovascular outcomes of febuxostat versus allopurinol in gout patients.

Findings

Febuxostat group had higher cardiovascular events (18.1%) compared to allopurinol (7.5%).

Death rates were similar between the two treatment groups (6% for allopurinol, 6.9% for febuxostat).

Higher risk factors in the febuxostat group may explain the increased cardiovascular events.

Abstract

Introduction/objectives: The primary goal of this study is the epidemiological observation and characterisation of a gout patient cohort. Following this, allopurinol, febuxostat, or no uric acid-lowering treatment was given, and cardiovascular events and deaths during the follow-up were noted. We precisely documented and studied each patient’s comorbidities and co-medications for the analysis.

Method: Our analysis included 208 gout patients, focusing on their epidemiological and clinical features. We monitored the treatment progress of 155 patients using the prescribed medications. Patients received treatment in the rheumatology department at Dresden University Hospital. On average, participants were followed up for 248.7 weeks (4.8 years). We conducted an association study, grouping participants based on their primary uric acid-lowering medication (if they used it for at least 60% of the follow-up period).

Results: In the follow-up, 7.5% of patients in the allopurinol group (five patients) and 18.1% (13 patients) in the febuxostat group experienced at least one cardiovascular event. Among participants primarily using allopurinol, four deaths (6%) were recorded, compared to five deaths (6.9%) among those mainly using febuxostat.

Conclusions: While the febuxostat group showed more events, this was associated with a higher prevalence of almost all risk factors. Interpreting study results and applying them practically remain difficult given the constellation’s commonality in clinical life; therefore, careful consideration is necessary.