Treatment of gout patients with impairment of renal function: a systematic literature review

Irene A van Echteld; Caroline van Durme; Louise Falzon; Robert B Landewé; Désirée M van der Heijde; Daniel Aletaha

doi:10.3899/jrheum.140462

Treatment of gout patients with impairment of renal function: a systematic literature review

J Rheumatol Suppl. 2014 Sep:92:48-54. doi: 10.3899/jrheum.140462.

Authors

Irene A van Echteld¹, Caroline van Durme², Louise Falzon², Robert B Landewé², Désirée M van der Heijde², Daniel Aletaha²

Affiliations

¹ From the Rheumatology Department, St. Elisabeth Hospital, Tilburg; the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; Atrium Medical Center, Heerlen; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria.I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre, and Rheumatology Department, Centre Hospitalier Universitaire; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; and Atrium Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna. [email protected].
² From the Rheumatology Department, St. Elisabeth Hospital, Tilburg; the Rheumatology Department, Maastricht University Medical Centre, Maastricht, The Netherlands; Rheumatology Department, Centre Hospitalier Universitaire, Liège, Belgium; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA; Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam; Atrium Medical Center, Heerlen; Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands; and Internal Medicine, Rheumatology Department, Medical University of Vienna, Vienna, Austria.I.A. van Echteld, MD, Rheumatology Department, St. Elisabeth Hospital; C. van Durme, MD, Rheumatology Department, Maastricht University Medical Centre, and Rheumatology Department, Centre Hospitalier Universitaire; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; R.B. Landewé, MD, PhD, Professor, Department of Clinical Immunology and Rheumatology, Academic Medical Center; and Atrium Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; D. Aletaha, MD, MSc, Internal Medicine, Rheumatology Department, Medical University of Vienna.

PMID: 25180128
DOI: 10.3899/jrheum.140462

Abstract

Objective: To assess the efficacy and safety of gout-specific medications in gout patients with a comorbidity and/or comedication.

Methods: A systematic literature search for gout, its medication, and the most common comorbidities and comedications, using serum uric acid (SUA) levels as the primary, and adverse events as the secondary outcomes.

Results: Eight trials met inclusion criteria. Trials covered treatment with allopurinol, benzbromarone, rasburicase, or febuxostat in a gout population with mild or moderate renal insufficiency. High risk of bias (5/8 trials) and heterogeneity precluded formal metaanalysis. The trials showed the following hierarchy in efficacy (lowering the SUA below 6.0 mg/dl): febuxostat 80 mg (44%-71%) > febuxostat 40 mg (43%-52%) > allopurinol 100 mg or 200 mg (0-46%) after 6 months of therapy; rasburicase (46%) > allopurinol 300 mg (16%) after 7 days of therapy; benzbromarone 100-200 mg (93%) > allopurinol 100-200 mg (63%) after 9-24 months of therapy. The combination of allopurinol and benzbromarone seemed to be effective, with a significant reduction in the SUA from 7.8 to 5.7 mg/dl (p < 0.05) after 1 month. One study showed that 89% achieved the target SUA using higher doses of allopurinol than usually recommended for patients with renal impairment without an apparent increase in adverse events. In addition, allopurinol and benzbromarone significantly improved renal function.

Conclusion: In gout patients with renal insufficiency febuxostat, rasburicase, benzbromarone, and allopurinol + benzbromarone seemed to be effective and safe; allopurinol may be cautiously titrated until the target uric acid level has been reached, and may improve renal function.

Keywords: ALLOPURINOL; BENZBROMARONE; FEBUXOSTAT; GOUT; RASBURICASE; RENAL IMPAIRMENT; RENAL INSUFFICIENCY.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Gout / complications
Gout / drug therapy*
Gout Suppressants / adverse effects
Gout Suppressants / therapeutic use*
Humans
Renal Insufficiency / complications*
Treatment Outcome

Substances

Gout Suppressants