For the treatment of gout in chronic kidney disease CKD patients, there needs to be more information about the relative efficacy of allopurinol (ALL) and febuxostat (FEB). In this analysis, researchers used information from the recently concluded multicenter RCT STOP-Gout to compare the efficacy and safety of ALL and FEB in the subgroup of patients with CKD. Serum urate (SU) concentration more than or equal to 6.8 mg/dL was used to determine which treatment, ALL or FEB, would be given to patients with gout. To achieve the desired SU of less than 6.0 mg/dL, ULT was titrated during weeks 0-24 (Phase 1) and maintained with escalation during weeks 25-48 (Phase 2). After 48 weeks of ULT treatment, participants were found to be maintaining a constant dosage (Phase 3). An eGFR between 30 and 59 mL/min/1.73 m2 was used to diagnose chronic kidney disease. As of Phase 3, the primary outcome was the existence of more than or equal to 1 gout flare. Secondary outcomes included the proportion of patients whose SU levels were less than 6 mg/dL by the conclusion of Phase 2, the frequency with which patients experienced gout attacks, and the incidence of major side effects serious adverse events (SAEs). Only 351 of the 940 trial participants were diagnosed with CKD, but 277 were evaluated for the primary outcome. Despite the similar achievement of SU less than 6.0 mg/dL by the end of Phase 2, fewer patients randomized to ALL had 1 gout flare during Phase 3 (32% v 45%; P=0.02). Participants with CKD did not need higher doses of either ULT to achieve objective SU compared to non-CKD participants, although they did have more SAEs. Between ALL and FEB, there were no significant variations in the total number of SAEs. This sub-analysis from a large randomized controlled trial shows that ALL and FEB are both effective and well tolerated for treating gout in CKD when using a treat-to-target strategy.
Source: asn-online.org/education/kidneyweek/2022/program-abstract.aspx?controlId=3770072
