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Cardiovascular risk associated with allopurinol or benzbromarone treatment in patients with gout
Yeonghee Eun1, Heewon Han2, Kyunga Kim2
1Division of Rheumatology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
This study found no significant difference in cardiovascular risk between gout patients treated with allopurinol or benzbromarone. These findings apply to both the general gout population and those at high cardiovascular risk.
Area of Science:
- Cardiology
- Rheumatology
- Pharmacology
Background:
- Gout patients exhibit increased cardiovascular (CV) risk.
- Uric acid-lowering therapies aim to mitigate this risk.
- Few studies directly compare allopurinol and benzbromarone for CV outcomes in gout.
Purpose of the Study:
- To compare the cardiovascular risk associated with allopurinol versus benzbromarone in Korean gout patients.
- To evaluate the safety and efficacy of these two common urate-lowering agents concerning major adverse cardiovascular events.
Main Methods:
- A nationwide, population-based, retrospective cohort study utilizing South Korea's HIRA database.
- Inclusion of gout patients aged 18+ who initiated allopurinol or benzbromarone between 2009-2015.
- Primary composite CV endpoint: coronary revascularization, myocardial infarction hospitalization, ischemic stroke, or transient ischemic attack; analyzed using Cox regression and Kaplan-Meier curves.
Main Results:
- The study included 257,097 allopurinol users and 7,868 benzbromarone users.
- Benzbromarone initiators showed an adjusted hazard ratio (aHR) of 1.01 (95% CI: 0.83-1.21) for the composite CV endpoint compared to allopurinol, a non-significant difference.
- Subgroup analysis in high-CV-risk patients also revealed no significant difference in CV event incidence between the two treatment groups.
Conclusions:
- No significant difference in cardiovascular risk was observed between patients initiating allopurinol and those initiating benzbromarone.
- This finding holds true for both the overall gout population and the subgroup of patients with pre-existing high cardiovascular risk.
Background:
In previous studies, cardiovascular (CV) risk was increased in patients with gout. The effects of uric acid-lowering therapy on CV risk in gout patients have been investigated in numerous studies; however, allopurinol and benzbromarone have rarely been compared.
Objectives:
To compare CV risk based on allopurinol and benzbromarone treatment in Korean gout patients.
Design:
A nationwide population-based retrospective cohort study.
Methods:
We used South Korea database of the Health Insurance Review and Assessment (HIRA) service to identify gout patients ⩾18 years of age who newly started allopurinol or benzbromarone between 2009 and 2015. The primary outcome of the study was the occurrence of a composite CV endpoint, which included coronary revascularization, hospitalization due to myocardial infarction, ischemic stroke, and transient ischemic attack. Cox proportional hazard regression analysis and Kaplan-Meier curves were used for analysis.
Results:
The study included 257,097 allopurinol initiators and 7868 benzbromarone initiators. Compared with allopurinol initiators, the adjusted hazard ratio (aHR) of the composite CV endpoint of benzbromarone initiators was 1.01 [95% confidence interval (CI): 0.83-1.21], which was not significantly different. The results did not change even when 1:3 propensity score matching was performed for baseline characteristics. In subgroup analysis of high-risk patients with CV disease, significant difference was not observed between allopurinol and benzbromarone initiators.
Conclusion:
In this study, significant difference was not found in CV risk between allopurinol and benzbromarone initiators. In the high-CV-risk group, the incidence of CV events did not differ between allopurinol and benzbromarone initiators.
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