Abstract: SA-PO653

Comparative Effectiveness of Allopurinol, Febuxostat, and Benzbromarone on Renal Function in CKD Patients with Hyperuricemia: A 13 Year Cohort Study

Session Information

Category: Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

  • 1601 Pharmacokinetics, Pharmacodynamics, Pharmacogenomics

Authors

  • Tsai, Ching-Wei, China Medical University Hospital, Taichung, Taiwan
  • Kuo, Chin-Chi, China Medical University Hospital, Taichung, Taiwan
Background

Direct comparisons of the effectiveness of allopurinol with that of other urate-lowering agents in chronic kidney disease (CKD) populations, as well as guideline recommendations for clinical practice, are lacking.

Methods

We constructed a pharmacoepidemiology cohort study by using patients from Taiwan’s long-term integrated CKD care program to compare the effectiveness among allopurinol, febuxostat, and benzbromarone in reducing the risk of progression to dialysis. A total of 874 patients with hyperuricemia who were newly treated with allopurinol, febuxostat, or benzbromarone were included. The primary and secondary outcomes were incident ESRD and the serum uric acid (SUA) changes from baseline, respectively. The results were analyzed using multiple Cox proportional models adjusted for multinomial propensity scores.

Results

Compared with allopurinol, benzbromarone therapy was associated with a reduced risk of progression to dialysis, the adjusted hazard ratio (aHR) was 0.50 (95% CI, 0.25–0.99). Patients who received allopurinol or febuxostat exhibited a comparable risk of end-stage renal disease [aHR, 0.99 (0.40–2.44)]. Febuxostat was significantly more potent than was allopurinol or benzbromarone in lowering SUA levels in the fully adjusted model. Among patients who reached the therapeutic target, those with febuxostat and benzbromarone initiation had a significantly lower risk of ESRD.

Conclusion

In conclusion, compared with conventional allopurinol, febuxostat and benzbromarone are more effective in reducing the risk of progression to dialysis and in lowering SUA levels in CKD populations.

Effect of serum uric acid and eGFR associated with allopurinol, febuxostat, and benzbromarone
Study drugsNChange from baseline (mg/dL)Percentage change from baseline (%)
Adjusted†Adjusted†
LSM (95% CI)LSM (95% CI)
Serum uric acid
Allopurinol308-1.49 (-1.82, -1.16)-13.70 (-16.90, -10.60)
Febuxostat133-3.71 (-4.18, -3.23)-36.70 (-41.30, -32.20)
Benzbromarone366-2.76 (-3.03, -2.49)-26.90 (-29.50, -24.30)
eGFR
Allopurinol247-4.68 (-6.44,-2.92)-16.92 (-24.81, -9.03)
Febuxostat95-2.22 (-4.91, 0.47)-10.64 (-22.70, 1.42)
Benzbromarone313-2.17 (-3.60, -0.74)-10.73 (-17.14, -4.31)

†Adjusted for propensity score and time since the index date to the last SUA measurement