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Allopurinol linked with reduced risk of renal disease compared with febuxostat
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Among older adults with gout, treatment with allopurinol was linked with a reduced risk of renal disease compared with treatment using febuxostat, according to results of a recently published study.
“This comparative effectiveness study showed that allopurinol was more effective than febuxostat and was associated with greater reduction in the risk of incident kidney disease in a nationally representative sample of older Americans,” Jasvinder A. Singh, MD, MPH, from the University of Alabama at Birmingham, and colleagues wrote. “The association of allopurinol with renal protection was dose-related, and possibly duration-related, with higher reduction of hazard of incident renal disease with higher allopurinol doses.”
Singh and colleagues performed a retrospective cohort study of Medicare claims data from 2006 to 2012 of 26,443 patients treated with either allopurinol or febuxostat. Per 1,000 person-years, the crude incidence rates were 192 for allopurinol and 338 for febuxostat. Per 1,000 person-years, the incidence rates per daily dose were 238 for a 200-mg dose of allopurinol; 176 for a 200-mg to 299-mg dose of allopurinol; 155 for an allopurinol dose of at least 300 mg; 341 for a 40-mg dose of febuxostat; and 326 for an 80-mg dose of febuxostat.
Compared with febuxostat, allopurinol was linked with a reduced risk for renal disease (hazard ratio [HR] = 0.61). Compared with a 40-mg dose of febuxostat, allopurinol doses of less than 200 mg were linked with a reduced risk for renal disease (HR = 0.75), as well as doses between 200 mg and 299 mg (HR = 0.61) and doses of at least 300 mg (HR = 0.48).
“A randomized trial is needed to confirm these findings,” the researchers wrote. “Future studies should also assess whether renal protection with allopurinol differs by the underlying etiology of renal disease, that is, hypertension versus diabetes versus heart failure versus others. Translational studies are also needed to uncover the underlying mechanisms of this potential renal function benefit associated with allopurinol use.” – by Will A. Offit
Disclosure: Singh reports he received research grants from Takeda and Savient and received consulting fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon, Allergen Pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology.
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