Allopurinol, Benzbromarone, or a Combination in Treating Patients with Gout: Analysis of a Series of Outpatients

Abstract

Objective. To profile a sample of gouty patients treated with allopurinol, benzbromarone, or a combination of these two drugs and to describe the impact of this therapy in reducing uric acid levels. Methods. An observational, transversal study was performed. We evaluated 48 patients diagnosed with gout who were seen at the Outpatient Rheumatology Clinic of the Federal University of Paraná between January 2009 and November 2010. Clinical data, creatinine serum levels, and basal and posttreatment levels of serum urates, transaminases, and bilirubins were recorded. Uric acid levels were measured in a 24-hour urine sample. Patients were divided into three groups: patients given only allopurinol (A), only benzbromarone (B), and both in combined therapy (A + B). Results. The average age of these patients was 56.6 ± 11.4 years, varying from 35 to 81 years. The entire patient group experienced a significant drop in serum urate levels, from 8.5 ± 1.8 mg/dL (0.472 ± 0.1 mmol/L) to 6.7 ± 2.1 mg/dL (0.372 ± 0.116 mmol/L) (P < 0.001), regardless of the prescribed medication. The number of patients taking both drugs whose serum uric acid values fell within normal range (men <7 mg/dL (0.38 mmol/L) and women <6 mg/dL (0.33 mmol/L)) was 85.7% (6/7) while this value for the group taking benzbromarone alone was 75% (3/4) and for the group taking allopurinol alone this number was 51.8% (14/27). Conclusions. The therapeutic combination of benzbromarone and allopurinol significantly decreased serum urate levels in patients with gout when compared to individual use of each of these agents. This finding is especially important in treating patients who cannot control hyperuricemia with monotherapy. Benzbromarone alone or in combination with allopurinol has an important clinical role in controlling hyperuricemia in patients with gout.

Poorly controlled gout: who is doing poorly?

“…The combination of drugs with different modes of action has also been shown to improve urate-lowering therapy. (7,33) Other drugs such as losartan, fenofibrate and oral vitamin C supplements also have direct uricosuric effects and may be considered for adjunctive treatment. (4) …”

Identification of Epoxide-Derived Metabolite(s) of Benzbromarone

“…Gout is a form of inflammatory arthritis caused by elevation of blood urate levels (a condition known as hyperuricemia), which crystallize and deposit into the joints and/or surrounding tissues (Saag and Choi, 2006;Azevedo et al, 2014). Benzbromarone (BBR) is a benzofuran derivative (as shown in Fig.…”

Flavonoids and phenylethanoid glycosides from Lippia nodiflora as promising antihyperuricemic agents and elucidation of their mechanism of action

“…Currently available antihyperuricemic agents are limited and divided into two major groups, namely xanthine oxidase inhibitors such as allopurinol and uricosuric agents such as benzbromarone. However, adverse effects like severe hypersensitivity reactions associated with allopurinol and severe hepatotoxicity risk of benzbromarone limit their therapy usage (Pacher et al, 2006;Azevedo et al, 2014).…”