Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Efficacy of Combined Treatment with Allopurinol and Benzbromarone in Gout Patients with Chronic Renal Impairment.
Oh1, Ji Seon, Choi1, Seung Won, Koo2, Bon San, So2, Min Wook, Kim2, Yong-Gil, Lee2, Chang-Keun, Yoo2, Bin
The management of hyperuricemia in gout patients with chronic renal impairment is difficult because of relatively high uric acid levels in such patients and a limitation in increasing doses of urate-lowering agents such as allopurinol. At the reduced doses proposed in the recommendations in such conditions, allopurinol alone may not decrease the serum urate concentration sufficiently to allow regression of tophi. Currently, the role of combination therapy with urate-lowering agents in such patients has not been well established. The purpose of this study is to evaluate the efficacy and safety of combined treatment with allopurinol and benzbromarone in hyperuricemic patients with moderate to severe renal impairment.
We retrospectively reviewed medial records of twenty gout patients with moderate to severe renal impairment (glomerular filtration rate (GFR) 1559 mL/min/1.73m2) who has been treated with both allopurinol and benzbromarone in our outpatient clinic between 2003 to 2011. We measured uric acid levels and GFR at baseline and during treatment with allopurinol before and after addition of benzbromarone. GFR was calculated by the Modification of Diet in Renal Disease (MDRD) equation. For statistical analysis, Wilcoxon test was used.
Mean age of patients was 61.0 ± 11.2. Mean uric acid levels and GFR at baseline was 10.4 ± 1.3 mg/dL and 38.4 ± 8.3 mL/min/1.73m2, respectively. Mean doses of allopurinol and benzbromarone were 197.5 ± 86.6 mg (range 100400 mg) and 47.5 ± 29.1 mg (range 25100 mg), respectively. Uric acid levels decreased from a mean of 10.4 ± 1.3 mg/dL to 5.6 ± 1.7 mg/dL (p<0.001). Of fourteen patients who treated with allopurinol alone at average doses of 193 mg/day before addition of benzbromarone, none had achieved the desired uric acid level (mean uric acid levels, 8.7 ± 1.4 mg/dL; mean reduction of uric acid levels, 1.9 ± 1.4 mg/dL, p<0.001). Fourteen (70%) of twenty patients with combination treatment reached the uric acid levels of <= 6.0 mg/dL. There was no serious adverse event including hepatic dysfunction during combination treatment. Benzbromarone was discontinued in one patient due to diarrhea. There were no significant changes in GFR during treatment with benzbromarone (mean changes in GFR, 1.1 ± 4.5 mL/min/1.73m2, p=0.298).
This study results suggest that combined treatment with allopurinol and benzbromarone may be an effective strategy for achieving the goal of uric acid levels in gout patients with moderate to severe renal impairment.
To cite this abstract, please use the following information:
Oh, Ji Seon, Choi, Seung Won, Koo, Bon San, So, Min Wook, Kim, Yong-Gil, Lee, Chang-Keun, et al; Efficacy of Combined Treatment with Allopurinol and Benzbromarone in Gout Patients with Chronic Renal Impairment. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1027