Эффективность фебуксостата у пациентов с подагрой в зависимости от функции почек

Abstract

Aim: to determine the probability of achieving the target serum uric acid (UA) level during therapy with febuxostat (in the tablet form) in patients with gout stratified depending on kidney function, including patients with type 2 diabetes mellitus (DM2). Patients and Methods: the study included patients over 18 years of age with gout who had not previously taken febuxostat or other urate- lowering drugs for at least 2 weeks before inclusion, with a serum UA level >360 μmoL/L. All were prescribed with febuxostat in the tablet form 80 mg/day. If the target serum UA level was not reached (<360 μmoL/L), the dosage level was increased up to 120 mg/day. Laboratory tests included the determination of blood glucose, creatinine, UA. Initially, patients were divided into groups according to chronic kidney disease (CKD) stages by the level of estimated glomerular filtration rate (eGFR) by CKD-EPI: C1 — high or optimal renal function (>90 mL/min/1.73 m2), C2 — slightly reduced renal function (60–89 mL/min/1.73 m2), C3 — moderately/considerably reduced renal function (30–59 mL/ min/1.73 m2), C4 — significantly reduced renal function (15–29 mL/min/1.73 m2). Patients with DM2 were analyzed separately. The follow-up period covered at least 26 weeks: the primary endpoint was to achieve the target serum UA level, and the eGFR tendency was also evaluated.Results: 136 patients with gout were examined. DM2 was in 38 (27.9%) patients. CKD C0–1 was detected in 30 (22.1%) patients, C2 — in 28 (20.6%), C3 — in 62 (45.6%), C4 — in 16 (11.8%). Febuxostat (in the tablet form) was received at a dose of 80 mg/day in 98 (72.1%) patients, 120 mg/day in 38 (27.9%) patients. There was the following preventive administration of anti-inflammatory therapy: colchicine — 59 (43.4%) patients, NSAIDs — 51 (37.5%) patients, glucocorticosteroids — 12 (8.8%) patients, no drug therapy — 14 (10.3%) patients. UA level significantly decreased in all groups, the average value of Δ MK and the frequency of achieving the target serum UA level were comparable. Achievement of the target serum UA level in general was in 84% of patients; in C0–1, C2, C3, C4 — in 83, 89, 82 and 81% of patients, respectively. The mean eGFR values relative to the baseline increased by the end of the study in all groups, but significant differences were only in patients with C0–1: 101.3±18.1 mL/min/1.73 m2 vs 102.8±28.6 mL/min/1.73 m2 (p=0.002). Of the 38 patients with DM2, 33 (87%) achieved the target serum UA level. In 2 patients with CKD C3, ALT and AST increased up to two norms (when taking febuxostat 120 mg/day). Conclusion: the possibility of achieving the target serum UA level when taking febuxostat (in the tablet form) in patients with gout does not depend on kidney function, including in patients with DM2. KEYWORDS: gout, febuxostat, glomerular filtration rate, chronic kidney disease, diabetes mellitus. FOR CITATION: Eliseev M.S., Zhelyabina O.V., Chikina M.N., Thakokov M.M. Febuxostat efficacy in patients with gout depending on kidney function. Russian Medical Inquiry. 2022;6(3):140–147 (in Russ.). DOI: 10.32364/2587-6821-2022-6-3-140-147.