Add on Benzbromarone outperformed febuxostat monotherapy in gout with combined-type hyperuricemia: JAMA

The research team conducted a prospective randomized trial on patients with combined-type hyperuricemia and estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2. They were randomly assigned in 1:1 ratio to febuxostat and benzbromarone combination therapy (initially febuxostat at 20 mg/day, with benzbromarone at 25 mg/day added onto 20 mg/day of febuxostat if not at target) or febuxostat monotherapy (initially 20 mg/day, escalating to 40 mg/day if not at target).

The primary endpoint at 12 weeks was the proportion achieving an SU level <360 μmol/L. Other outcomes were altered kidney and liver function, gout flares, and new-onset urolithiasis.

Following were the study’s key findings:

• Two hundred and fifty participants were randomized; 219 completed 12-week treatment.
• More patients in the febuxostat and benzbromarone combination group achieved the SU target compared to patients in the febuxostat monotherapy group (75.5% vs 47.7%; odds ratio 3.37).
• Safety profiles were comparable between the two groups.

The findings showed the superiority of low-dose benzbromarone add-on to low-dose febuxostat compared with febuxostat monotherapy in gout with combined-type hyperuricemia.

"For selected patients, expedited achievement of the SU target in more than 75% of patients using one titration step and low xanthine oxidase inhibitor and uricosuric doses is a potential alternative to standard ULT regimens," the researchers concluded.

Reference:

Xue, X., Sun, M., Yan, F., Dalbeth, N., He, Y., Li, X., Qi, H., Chen, Y., Yuan, X., Li, M., Ji, A., Terkeltaub, R., & Li, C. Superiority of Low-Dose Benzbromarone Add-On to Low-Dose Febuxostat Compared With Febuxostat Monotherapy in Gout With Combined-Type Hyperuricemia. Arthritis Care & Research. https://doi.org/10.1002/acr.25283