Abstract
Benzbromarone and febuxostat use different mechanisms to reduce serum urate. However, the effectiveness of benzbromarone versus febuxostat in reducing serum urate in gouty patients classified with different types of hyperuricaemia remains unclear. In this retrospective study from January 1, 2018, to September 30, 2020, subjects were identified if they were newly treated with benzbromarone 25mg daily or febuxostat 20mg daily. The subjects were classified into four types according to their 24-h urinary uric acid and fractional excretion of uric acid. The baseline data and follow-up information after 28 ± 3days of treatment were collected. Seventy-three subjects with gout were finally enrolled. Among them, 50 were treated with benzbromarone. The percent changes in serum urate from the baseline were - 33.71 ± 13.59% and - 29.45 ± 10.62% in the benzbromarone and febuxostat group, respectively, without a significant difference between the groups (P = 0.188). No differences were found between the groups in subjects classified as the renal underexcretion type, combined type, or "normal" type. In patients with eGFR ≥ 70mL/min/1.73 m2, the rate of serum urate lowering was higher in those treated with benzbromarone than in those treated with febuxostat. Febuxostat treatment significantly lowered serum creatinine from the baseline (P = 0.001). Benzbromarone 25mg daily and febuxostat 20mg daily may have comparable effectiveness in lowering the serum urate among different types of hyperuricaemia. Benzbromarone was more effective than febuxostat in lowering serum urate in subjects with eGFR ≥ 70mL/min/1.73 m2, while febuxostat had a renal protective effect. Key Points • Benzbromarone 25mg daily and febuxostat 20mg daily may have comparable effectiveness in lowering the serum urate inpatients withdifferent types of hyperuricaemia. • Benzbromarone 25mg daily was more effective than febuxostat 20mg daily in lowering serum urate in subjects with eGFR ≥ 70mL/min/1.73 m2. • Febuxostat had a renal protective effect after about 1month treatment.
Highlights
Gout is the most common inflammatory arthritis that is caused by elevated serum urate and subsequent deposition of monosodium urate crystals
The percent changes in serum urate from the baseline were -33.71 ± 13.59% in benzbromarone group and -29.45 ± 10.62% in febuxostat group without significant difference between the two groups (P = 0.188)
In patients with eGFR ≥ 70 mL/min/1.73m2, the rate of serum urate lowering was higher in those treated with benzbromarone than febuxostat
Summary
Gout is the most common inflammatory arthritis that is caused by elevated serum urate and subsequent deposition of monosodium urate crystals. Hyperuricemia is a disease with genetic predisposition, which is caused by the decreased excretion of urate by the kidneys or the gut and/or overproduction of uric acid in the liver[1, 2]. Maintaining serum urate levels < 6 mg/dL could reduce gouty tophus and decrease frequency of gout flares[3]. Benzbromarone, an uricosuric agent, is a first-line urate lowering drug according to the Chinese gout management guideline and is the most prescribed urate lowering drug in China[6]. Its urate-lowering effect maintains even in gouty patients with mild to moderate renal dysfunction[7, 8]. Benzbromarone and febuxostat have different mechanisms in reducing serum urate. The effectiveness of benzbromarone versus febuxostat in reducing serum urate in gouty patients classified with different types of hyperuricemia remain unclear
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