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Fenofibrate reduces gout incidence in type 2 diabetes
Adults with type 2 diabetes and high levels of uric acid assigned the dyslipidemia medication fenofibrate experienced a 20% reduction in uric acid concentration and a nearly 50% reduction in first on-study gout events over 5 years, according to a post hoc analysis of the FIELD study.
“Hyperuricemia is increasingly common, especially in populations with high frequencies of obesity and metabolic syndrome such as our cohort,” Boris Waldman, MBBS, a research fellow with the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney, and colleagues wrote. “Uric acid concentrations typically increase with increasing number of metabolic syndrome components, although patients with diabetes and glycosuria might actually have lower uric acid concentrations.”
Waldman and colleagues analyzed data from 9,795 adults aged 50 to 75 years with type 2 diabetes randomly assigned 200 mg fenofibrate daily (n = 4,895) or placebo (m = 4,900) for a median of 5 years. Follow-up occurred every 4 months for the first year and every 6 months after. Researchers assessed recorded on-study gout attacks and plasma uric acid concentrations by treatment allocation, as well as the uptake of gout-specific drugs, including allopurinol, colchicine and probenecid.
During the 6-week run-in phase, patients assigned fenofibrate experienced a mean 20.2% reduction in uric acid concentration (95% CI, 19.9-20.5) that persisted over 1 year vs. placebo (between-group difference, 20%; P < .0001). The fall in plasma uric acid at 1 year was less for patients assigned fenofibrate and already taking allopurinol (mean, 10.3% vs. 20.8%; P < .0007).
During 5 years of follow up, 151 patients in the placebo arm (3%) and 81 patients in the fenofibrate arm (2%) experienced at least one gout event (HR = 0.54; 95% CI, 0.41-0.7). Researchers found that the cumulative proportion of patients who experienced a first gout event for the placebo vs. fenofibrate arms was 3.1% vs. 1.7%.
Among patients with baseline plasma uric acid concentration of at least 0.36 mmol/L, the cumulative proportion of patients experiencing a first gout event was 7.7% vs. 3.4% for the placebo vs. fenofibrate arms, and 13.9% vs. 5.7%, respectively, for patients with baseline plasma uric acid concentration of at least 0.42 mmol/L.
There were no between-sex differences observed, and results were similar for participants with dyslipidemia, on diuretics and with elevated uric acid levels, according to researchers.
“The most clinically relevant and important finding from these post hoc analyses was that fenofibrate therapy almost halved the rate of incident episodes of acute gout,” the researchers wrote. “The event rates separated early and continued to diverge for the duration of the study.”
The researchers noted that fenofibrate could be a useful adjunct for treating gout in individuals with diabetes. – by Regina Schaffer
Disclosures: Waldman reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.