EHJ: The cardiovascular risk of "two kings" allopurinol and benzbromarone in gout patients

Gout attacks are severely painful disabling inflammatory arthritis, usually involving a single joint, but sometimes also involving 2 or more joints
.

The goal of treatment at this time is to relieve pain and disability quickly and safely

Gout attacks are severely painful disabling inflammatory arthritis, usually involving a single joint, but sometimes also involving 2 or more joints

There are several types of anti-inflammatory drugs that can effectively treat gout attacks, including systemic and intra-articular injections of glucocorticoids, non-steroidal anti-inflammatory drugs (NSAID), colchicine, and biological agents that inhibit IL-1β
.

The basic requirements should meet the principle of "early treatment, early prevention, and lowering of uric acid"

Continue uric acid-lowering therapy during the attack – patients who are already receiving uric acid-lowering medications (for example, allopurinol, febuxostat, probenecid, benzbromarone, or polyethylene glycol recombinant uricase) at the time of the attack should continue Don't interrupt treatment
.

There is no benefit to suspending the medication, and reusing after a period of discontinuation may induce gout attacks

There is no benefit to suspending the medication, and reusing after a period of discontinuation may induce gout attacks

Among them, allopurinol and benzbromarone are the two cornerstones of uric acid-lowering treatment for patients with gout

In order to compare the risk of CVD in gout patients who started using allopurinol and benzbromarone, experts from the Department of Internal Medicine and Rheumatology, Bundang Hospital, Seoul National University, Korea conducted a related study, and the results were published in the European Journal of Cardiology, EHJ
.

Using Korean National Health Insurance claims data (2002-17), researchers conducted a cohort study of 124,434 gout patients who started using allopurinol (n = 103695) or benzbromarone (n = 20739), press 5 :1 ratio for propensity score matching
.

The main outcome is a composite CVD endpoint of myocardial infarction, stroke/transient ischemic attack, or coronary revascularization

During an average follow-up of 1.
16 years, 2258 patients experienced compound CVD events
.

The incidence of compound CV events in allopurinol-initiated patients (1.

The incidence of compound CV events in allopurinol-initiated patients (1.

KM curve of patients using allopurinol and benzbromarone

In addition, compared with allopurinol, benbromarone users have a slightly higher incidence of CVD complications: atrial fibrillation (4.
2% vs.
3.
3%), hypertension (53.
1% vs.
49.
3%), chronic kidney disease (13.
1 % Vs.
9.
2%), dyslipidemia (43.
5% vs.
36.
6%), and diabetes (27.
9% vs.
26.
4%)
.

The cumulative steroid dose of benzbromarone users is also higher than that of allopurinol users

Compared with allopurinol, benzbromarone users have a slightly higher incidence of CVD complications: atrial fibrillation (4.
2% vs.
3.
3%), hypertension (53.
1% vs.
49.
3%), chronic kidney disease (13.
1% vs.
9.
2%), dyslipidemia (43.
5% vs.
36.
6%) and diabetes (27.
9% vs.
26.
4%)
.
The cumulative steroid dose of benzbromarone users is also higher than that of allopurinol users
.
Compared with allopurinol, benzbromarone users have a slightly higher incidence of CVD complications: atrial fibrillation (4.
2% vs.
3.
3%), hypertension (53.
1% vs.
49.
3%), chronic kidney disease (13.
1% vs.
9.
2%), dyslipidemia (43.
5% vs.
36.
6%) and diabetes (27.
9% vs.
26.
4%)
.
The cumulative steroid dose of benzbromarone users is also higher than that of allopurinol users
.

The Charlson-Deyo comorbidity scores (± standard deviation, SD) of benzbromarone and allopurinol users were 1.
62±1.
81 and 1.
51±1.
83, respectively
.
Among benzbromarone users, laboratory tests for blood lipid levels (61.
5% vs.
53.
2%), renal function (62.
1% vs.
54.
6%), and uric acid levels (65.
8% vs.
61.
6%) were more frequent
.

Different follow-up time
.
Differences in CVD events in patients using allopurinol and benzbromarone

In summary, compared with benzbromarone, allopurinol is associated with an increased risk of compound CVD events and all-cause death.
Benzbromarone may reduce the risk of CV and mortality in patients with gout
.

In summary, compared with benzbromarone, allopurinol is associated with an increased risk of compound CVD events and all-cause death.
Benzbromarone may reduce the risk of CV and mortality in patients with gout
.
In summary, compared with benzbromarone, allopurinol is associated with an increased risk of compound CVD events and all-cause death.
Benzbromarone may reduce the risk of CV and mortality in patients with gout
.

references:

Cardiovascular risk associated with allopurinol vs.
benzbromarone in patients with gout, European Heart Journal, 2021;, ehab619, https://doi.
org/10.
1093/eurheartj/ehab619

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