What is the Place for Uricosuric Agents in Gout Management?

Siddiq, Md Abu Bakar; Jansen, Tim; Rasker, Johannes J.

doi:10.2174/1573397118666220308160124

Cited by 1 publication

(4 citation statements)

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“…Gout patients can be characterized by clinical manifestations of arthritic attacks with hyperuricemia plus a low urate excretion due to either low GFR or, more specifically, low FeUA [1,2]. We here demonstrate from a retrospective cohort that subdivision into low versus non-low (normal to high) FeUA status may help clinicians to find the right profile for uricosurics: a low FeUA may increase by factor 4 using a potent uricosuric such as benzbromarone, which enables achieving lower biochemical sUA targets; moreover, the tolerance of benzbromarone appears to be best in these low-excretors.…”

Section: Discussionmentioning

confidence: 99%

“…The therapeutic approach in gout, in general, is a dietary limitation of purines and/or urate production inhibitors by XOi, i.e., allopurinol or febuxostat. Their doses are being escalated to reach a predefined clinical and biochemical target [1,2]. If escalated doses are not tolerated, or targets cannot be achieved, then uricosurics may be considered, i.e., probenecid in the USA and benzbromarone in some European countries including the Netherlands, Spain, Germany, as well as Brazil [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…A decreased renal urate excretion is the predominant driver of attracting gout, an auto-inflammatory arthritic disease that may develop secondary to hyperuricemia [1,2]. There is an interest in effective uratelowering therapies with a uricosuric mode of action.…”

Section: Introductionmentioning

confidence: 99%

“…This applies in particular for gout patients in whom urate production inhibitors such as the xanthine oxidase inhibitors (XOi) allopurinol and/or febuxostat are failing or induce side effects [2]. The development of safe uricosurics has been complicated for decades [3] as only benzbromarone and probenecid were approved and selectively marketed in only specific countries [1][2][3]. During the last decade, novel uricosurics were developed, and specific targets were discovered blocking intrarenal urate transporter 1 (URAT1) and/or organic anion transporter 3 (OAT3) or OAT4 URATs.…”

Section: Introductionmentioning

confidence: 99%

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Lessons to be learned from real life data from 98 gout patients using benzbromarone

Hotea,

Janssen,

Jansen

2023

Explor Musculoskeletal Dis

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Aim: This study aims to analyze the efficacy and safety of benzbromarone as uricosuric, in a real-life clinical setting of a retrospective hospital-based gout cohort. Methods: Data from gout patients were retrieved from the digital hospital dossiers. Demographics, clinical variables, and laboratory parameters were collected at baseline and 6 months. Efficacy was measured by reaching a serum uric acid (sUA) target < 0.30 mmol/L at 6 months, and the fractional excretion of uric acid (FeUA) was used as a parameter with a potential predictor value. Results: Data from 98 gout patients were analyzed. Patients were 70 (± 12) years of age, and 90% were male. After 6 months of treatment, 68 out of 98 patients (69%) reached a sUA level < 0.30 mmol/L (5 mg/dL). In patients with a FeUA < 4.5%, so-called low excretors, the FeUA increase was most impressive from 3.2% (± 1.0%) to 12.1% (± 6.9%) after 6 months of benzbromarone treatment (mean increase +8.9% [95% confidence interval (CI): +6.5 to +11.5%], P < 0.001). In non-low excretors, FeUA was on average 7.3% (± 5.1%) and increased to 9.7% (± 6.1%): a mean +2.1% change (95% CI: –2.2 to +6.6%). The increase differed insignificantly in low versus non-low excretors: P > 0.05. Four patients stopped benzbromarone treatment because of a progressive decline in renal function, a condition that was already present before benzbromarone was initiated. Remarkably 38% of patients still using benzbromarone after 3.8 (± 3.4) years of treatment. Conclusions: Using the uricosuric benzbromarone in real-life gout patients proved effectivity in lowering sUA levels within 6 months by increasing FeUA significantly. Particularly low excretors benefit from benzbromarone treatment manipulating this mode of action. Determining FeUA in gout patients may further help to find the patient profile benefiting the most from benzbromarone treatment.

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Section: Discussionmentioning

confidence: 99%