OP0188 Effects of allopurinol versus febuxostat on cardiovascular risk in korean patients with gout: a nation-wide cohort study

Abstract

BackgroundGout is associated with an increased risk of cardiovascular (CV) disease.ObjectivesWe aimed to investigate comparative CV risk among gout patients who initiated allopurinol versus febuxostat.MethodsUsing the 2002–2015 Korean National Health Insurance Service (KNHIS) data for the whole Korean population, we conducted a cohort study on patients aged ≥40 years who had ICD-10 diagnosis code for gout and initiated allopurinol or febuxostat without prior history of urate lowering therapy, excluding those with chronic kidney disease, cancer, or dialysis treatment. The primary outcome was a composite CV endpoint of hospitalisation for myocardial infarction, stroke/transient ischaemic attack, or coronary revascularisation. Secondary outcomes were individual components of the primary outcome, and hospitalisation for heart failure (HF). Follow-up time started from the day after the first date the study drug was initiated and continued through to the earliest date among the following censoring events: discontinuation of the study drugs, outcome occurrence, disenrollment, end of study dataset, or death. After propensity score (PS)-matching with a 4:1 ratio for allopurinol and febuxostat initiators to adjust for baseline confounding, we estimated hazard ratio (HR) and 95% confidence interval (CI) of CV risks in allopurinol initiators versus febuxostat.ResultsWe included 39 636 allopurinol initiators PS-matched on 9909 febuxostat initiators with a mean age of 59 years and 78% male. Before PS matching, baseline CV risk factors including hypertension, dyslipidemia, diabetes, and previous ischaemic heart disease were more prevalent in febuxostat initiators. The incidence rate per 100 person-years for primary composite endpoint was 2.33 in allopurinol and 2.12 in febuxostat initiators in the primary as-treated analysis. The HR (95% CI) for the primary outcome associated with allopurinol was 1.18 (0.98–1.42) versus febuxostat. Secondary outcome analyses showed similar results (table 1).Abstract OP0188 – Table 1Risk of cardiovascular events in allopurinol versus febuxostat initiatorsAllopurinol (n=39,636)Febuxostat (n=9,909)HR(95% CI) Events (n)person-yearsIncidence rate per 100 person-yearEvents (n)person-yearsIncidence rate per 100 person-year AS-TREATED ANALYSISPrimary outcomeComposite CV end point73531 6052.3313362722.121.18(0.98–1.42)Secondary outcomesMI10531 5280.332062690.321.03(0.64–1.68)Coronary revascularisation21531 5460.683162690.491.42(0.97–2.08)Stroke/TIA49831 5721.589462711.501.14(0.91–1.43)Heart failure95630 6113.1220661083.371.15(0.99–1.34)Propensity-score matching was used to adjust more than 50 covariates including demographic characteristics, medical comorbidities such as CV risk factors, use of gout specific and non-specific medications, and health care utilisation pattern. CI=confidence interval; CV=cardiovascular; HR=hazard ratio; MI=myocardial infarction; TIA=transient ischaemic attackConclusionsIn this large Korean population-based cohort study, CV risks appear to be numerically, but not statisticall...

Comparative cardiovascular risk in users versus non-users of xanthine oxidase inhibitors and febuxostat versus allopurinol users

“…In one observational study investigating XOI use in gout patients with stage or 4 chronic kidney disease, those taking febuxostat were less likely to experience major cardiovascular events defined as coronary artery disease, cerebrovascular disease, and peripheral vascular disease and heart failure [5]. In a Korean nationwide cohort study, the composite cardiovascular endpoint of hospitalisation for myocardial infarction, stroke/transient ischaemic attack, or coronary revascularisation tended to be higher with allopurinol than with febuxostat [39]. An recently published observational study, febuxostat demonstrated a better cardioprotective effect than allopurinol in patients with heart failure [40].…”