E055 Benzbromarone treatment in refractory gout: Sheffield Teaching Hospital’s experience

Background/Aims Benzbromarone is a potent uricosuric agent used in treatment for gout. It can be used in combination with xanthine oxidase inhibitors. There have been reports of severe hepatoxicity and the benzbromarone use in the UK remains low. We have performed a retrospective review of our experience of benzbromarone use in Sheffield. Methods Retrospective review of outpatient prescriptions for benzbromarone from the rheumatology department in Sheffield, between April 2024 and May 2025. Results 16 patients were identified. 14 males (87.5%) and 2 females (12.5%), with a mean age of 67 years old. 10 patients had a diagnosis of polyarticular gout and 6 had tophaceous gout. 13 (81%) patients had tried xanthine oxidase inhibitors (XOI), including allopurinol and febuxostat. There were 3 patients for whom XOI was contraindicated due to ischaemic heart disease and concomitant use of azathioprine. Three patients stopped benzbromarone due to patient choice, deranged liver function tests (LFT) and haemodialysis. Mean dose of benzbromarone was 100mg daily. The duration of benzbromarone treatment ranged from 1 to over 10 years. 40% of patients were on combination treatment with XOI. Five patients had CKD stage 3 or above. Pre-treatment, the mean serum uric acid (SUA) was 536 mg/dL. 12 months post-benzbromarone treatment, the average decrease in SUA was 36% (214 mg/dL). SUA increased in 2 patients; however, both stopped taking benzbromarone, one due to abnormal LFT and the other due to patient choice. Two patients had abnormal LFTs, which prompted a non-invasive liver screen and abdominal ultrasound. One patient’s LFT recovered spontaneously and they continued on a reduced dose of benzbromarone. Eleven (69%) patients remain in remission. Five (31%) patients have refractory gout with recurrent flares or poor SUA control, of whom 4 have tophaceous gout and 4 have poor treatment compliance. Conclusion Our experience demonstrates that benzbromarone effectively lowers SUA in polyarticular or tophaceous gout. Combination therapy with XOI should be considered in those patients with refractory or tophaceous gout. LFT derangement is an uncommon complication of benzbromarone, and patients should have a minimum of 6 months of LFT monitoring (6-monthly monitoring when stable, monthly LFTs for the first 6 months as the highest risk of hepatotoxicity is in the first 6 months). Disclosure C.A. Zollinger-Read: None. M. Kazmi: None. C. Jogia: None.