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As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout.
Rheumatol Int. 2014 Jan; 34(1):101-9.RI

Abstract

We prospectively evaluated whether an effective 12-month uric acid-lowering therapy (ULT) with the available xanthine oxidase (XO) inhibitors allopurinol and febuxostat in patients with chronic tophaceous gout has an impact on oxidative stress and/or vascular function. Patients with chronic tophaceous gout who did not receive active ULT were included. After clinical evaluation, serum uric acid levels (SUA) and markers of oxidative stress were measured, and carotid-femoral pulse wave velocity (cfPWV) was assessed. Patients were then treated with allopurinol (n = 9) or with febuxostat (n = 8) to target a SUA level ≤ 360 μmol/L. After 1 year treatment, the SUA levels, markers of oxidative stress and the cfPWV were measured again. Baseline characteristics of both groups showed no significant differences except a higher prevalence of moderate impairment of renal function (estimated glomerular filtration rate <60 ml/min) in the febuxostat group. Uric acid lowering with either inhibitors of XO resulted in almost equally effective reduction in SUA levels. The both treatment groups did not differ in their baseline cfPWV (allopurinol group: 14.1 ± 3.4 m/s, febuxostat group: 13.7 ± 2.7 m/s, p = 0.80). However, after 1 year of therapy, we observed a significant cfPWV increase in the allopurinol group (16.8 ± 4.3 m/s, p = 0.001 as compared to baseline), but not in the febuxostat patients (13.3 ± 2.3 m/s, p = 0.55). Both febuxostat and allopurinol effectively lower SUA levels in patients with severe gout. However, we observed that febuxostat also appeared to be beneficial in preventing further arterial stiffening. Since cardiovascular events are an important issue in treating patients with gout, this unexpected finding may have important implications and should be further investigated in randomized controlled trials.

Authors+Show Affiliations

Department of Rheumatology, University Clinic "Carl Gustav Carus" at the Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany, anne-kathrin.tausche@uniklinikum-dresden.de.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

24026528

Citation

Tausche, A-K, et al. "As Compared to Allopurinol, Urate-lowering Therapy With Febuxostat Has Superior Effects On Oxidative Stress and Pulse Wave Velocity in Patients With Severe Chronic Tophaceous Gout." Rheumatology International, vol. 34, no. 1, 2014, pp. 101-9.
Tausche AK, Christoph M, Forkmann M, et al. As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout. Rheumatol Int. 2014;34(1):101-9.
Tausche, A. K., Christoph, M., Forkmann, M., Richter, U., Kopprasch, S., Bielitz, C., Aringer, M., & Wunderlich, C. (2014). As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout. Rheumatology International, 34(1), 101-9. https://doi.org/10.1007/s00296-013-2857-2
Tausche AK, et al. As Compared to Allopurinol, Urate-lowering Therapy With Febuxostat Has Superior Effects On Oxidative Stress and Pulse Wave Velocity in Patients With Severe Chronic Tophaceous Gout. Rheumatol Int. 2014;34(1):101-9. PubMed PMID: 24026528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout. AU - Tausche,A-K, AU - Christoph,M, AU - Forkmann,M, AU - Richter,U, AU - Kopprasch,S, AU - Bielitz,C, AU - Aringer,M, AU - Wunderlich,C, Y1 - 2013/09/12/ PY - 2013/05/01/received PY - 2013/08/30/accepted PY - 2013/9/13/entrez PY - 2013/9/13/pubmed PY - 2014/10/14/medline SP - 101 EP - 9 JF - Rheumatology international JO - Rheumatol Int VL - 34 IS - 1 N2 - We prospectively evaluated whether an effective 12-month uric acid-lowering therapy (ULT) with the available xanthine oxidase (XO) inhibitors allopurinol and febuxostat in patients with chronic tophaceous gout has an impact on oxidative stress and/or vascular function. Patients with chronic tophaceous gout who did not receive active ULT were included. After clinical evaluation, serum uric acid levels (SUA) and markers of oxidative stress were measured, and carotid-femoral pulse wave velocity (cfPWV) was assessed. Patients were then treated with allopurinol (n = 9) or with febuxostat (n = 8) to target a SUA level ≤ 360 μmol/L. After 1 year treatment, the SUA levels, markers of oxidative stress and the cfPWV were measured again. Baseline characteristics of both groups showed no significant differences except a higher prevalence of moderate impairment of renal function (estimated glomerular filtration rate <60 ml/min) in the febuxostat group. Uric acid lowering with either inhibitors of XO resulted in almost equally effective reduction in SUA levels. The both treatment groups did not differ in their baseline cfPWV (allopurinol group: 14.1 ± 3.4 m/s, febuxostat group: 13.7 ± 2.7 m/s, p = 0.80). However, after 1 year of therapy, we observed a significant cfPWV increase in the allopurinol group (16.8 ± 4.3 m/s, p = 0.001 as compared to baseline), but not in the febuxostat patients (13.3 ± 2.3 m/s, p = 0.55). Both febuxostat and allopurinol effectively lower SUA levels in patients with severe gout. However, we observed that febuxostat also appeared to be beneficial in preventing further arterial stiffening. Since cardiovascular events are an important issue in treating patients with gout, this unexpected finding may have important implications and should be further investigated in randomized controlled trials. SN - 1437-160X UR - https://www.unboundmedicine.com/medline/citation/24026528/As_compared_to_allopurinol_urate_lowering_therapy_with_febuxostat_has_superior_effects_on_oxidative_stress_and_pulse_wave_velocity_in_patients_with_severe_chronic_tophaceous_gout_ L2 - https://dx.doi.org/10.1007/s00296-013-2857-2 DB - PRIME DP - Unbound Medicine ER -