Key result
In patients with gout and elevated serum uric acid levels, treatment with febuxostat did not significantly change carotid-femoral pulse wave velocity compared to allopurinol over 36 weeks (P=0.5798).
Why the study?
Hyperuricaemia and gout are strongly related to traditional cardiovascular risk factors and vascular damage, but whether febuxostat and allopurinol differentially influence carotid-femoral pulse wave velocity was unclear.
Does febuxostat improve carotid-femoral pulse wave velocity compared to allopurinol in adults with gout and elevated serum uric acid levels?
RCT (n=197)
Open-label
1:1
Yes
Does febuxostat improve carotid-femoral pulse wave velocity compared to allopurinol in adults with gout and elevated serum uric acid levels?
Absolute Event Rate: 9% vs 9.05%
p-value: p=0.5798
In patients with gout and elevated serum uric acid, intensive urate-lowering therapy with febuxostat or allopurinol did not significantly improve arterial stiffness over 36 weeks, though febuxostat achieved target urate levels more effectively.
Febuxostat confers no arterial stiffness benefit over allopurinol in gout; confirms equivalent vascular effects between xanthine oxidase inhibitors.
AIMS: Hyperuricaemia and gout are strongly related with traditional cardiovascular risk factors and vascular damage. This study aimed to assess whether febuxostat and allopurinol could differently influence carotid-femoral pulse wave velocity (cfPWV) in patients with gout and elevated serum uric acid (SUA) levels. METHODS AND RESULTS: A multi-centre, multinational, phase IV, randomized, parallel-group, active-controlled, open-label trial with blind endpoints evaluation. One hundred and ninety-seven adults with gout and SUA levels ≥8 mg/dL were randomized to febuxostat or allopurinol in a 1:1 ratio for 36 weeks. The primary outcome was the comparison of the effects of febuxostat and allopurinol on changes in cfPWV. The mean cfPWV values at randomization and Week 36 were 8.69 and 9.00 m/s, respectively for subjects randomized to febuxostat and 9.02 and 9.05 m/s for subjects randomized to allopurinol. No statistically significant changes in cfPWV by treatment assignment were observed at any time point for any of the assessed parameters. More subjects who received febuxostat had serum urate concentrations ≤6 mg/dL following treatment (78.3% vs. 61.1% at Week 36, P = 0.0137). Treatment-emergent adverse events were reported by 51 (52.0%) patients randomized to febuxostat and 63 (62.5%) patients randomized to allopurinol. The majority of events were mild in both treatment groups and included gout flares and arthralgia. CONCLUSION: In patients with gout and elevated SUA levels the arterial stiffness remained stable both with febuxostat and allopurinol. Febuxostat was more effective and faster than allopurinol in achieving the SUA target. Both treatments were safe and well tolerated.
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Desideri et al. (2020) conducted an RCT in Gout and elevated serum uric acid (n=197). Febuxostat vs. Allopurinol 100 mg once daily was evaluated on Change in carotid-femoral pulse wave velocity (cfPWV) at 36 weeks (p=0.5798). In patients with gout and elevated serum uric acid levels, treatment with febuxostat did not significantly change carotid-femoral pulse wave velocity compared to allopurinol over 36 weeks (P=0.5798).
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