Comparing Cardiovascular Safety of Febuxostat and Allopurinol in the Real World: A Population-Based Cohort Study

Comparative effects of topiroxostat and febuxostat on arterial properties in hypertensive patients with hyperuricemia

“…Patients were instructed to measure their morning home BP (two readings within 1 h after waking, taken after urination, before taking morning medications and after 1-2 min of seated rest) and evening home BP (two readings before bedtime after 1-2 min of seated rest) on five successive days immediately prior to their scheduled clinic visit. Plasma XOR activity measurement was performed by Sanwa Kagaku Kenkyusho Co., Ltd. using liquid chromatography/triple quadrupole mass spectrometry (LC/ TQMS; Nexera HLC, SHIMADZU, Japan/QTRAP 4500, SCIEX) to detect [ 13 C 2 , 15 N 2 ]uric acid using [ 13 C 2 , 15 N 2 ]xanthine as a substrate, as previously reported. 23…”

“…14 However, data are limited, 12 findings are not consistent, and there is some concern about the cardiovascular safety of allopurinol and febuxostat. 15,16 Data on the effects of XORi on arterial properties, including flow-mediated dilatation (FMD) and pulse wave velocity (PWV), are also inconsistent. Some studies have shown benefit [17][18][19][20] and others no effect.…”

Effects of Febuxostat on Mortality and Cardiovascular Outcomes

“…32,33 This cardioprotective effect could be attributed to the lower frequent of gout flares which has a detrimental effect on the cardiovascular system. 34 On the other hand, using data from an observational cohort study from Taiwan, Su et al 35 found a significant increased risk of adverse cardiovascular events and mortality with febuxostat and the association was dose dependent. In 2018, White et al 9 published the CARES trial, which was the largest reported RCT that evaluated the cardiovascular safety of febuxostat in patients with gout compared with allopurinol.…”

Cardiovascular Safety of Febuxostat Versus Allopurinol in the Real World: Old Reliable Comes Out on Top

“…Febuxostat is only initiated when allopurinol is ineffective at achieving goal uric acid levels (or in individuals who are intolerant to allopurinol); thus, perhaps this individual by being more resistant to standard treatment is selectively at higher risk from their hyperuricemia than those who achieve success with allopurinol alone. Although Su et al 13 could not elucidate a reason for the elevated CV risk seen with febuxostat users, they highlight the importance of being cognizant that risk does appear to exist; however, the why and to whom remains unclear.…”

“…In the current issue of Mayo Clinic Proceedings, Su et al 13 undertook the task of assessing CV safety of febuxostat and allopurinol in a population-based cohort. Their retrospective review using the Taiwan National Health Insurance Research Database compared the risk of major adverse CV events, venous thromboembolism, heart failure (HF) hospitalizations, atrial fibrillation (AF) hospitalizations, CV death, and all causemortality in new users of febuxostat and allopurinol.…”