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Xue, Xiaomei; Sun, Mingshu; Yan, Fei; Dalbeth, Nicola; He, Yuwei; Li, Xinde; Qi, Han; Chen, Ying; Yuan, Xuan; Li, Maichao; Ji, Aichang; Terkeltaub, Robert; Li, Changgui

Superiority of Low‐Dose Benzbromarone Add‐On to Low‐Dose Febuxostat Compared With Febuxostat Monotherapy in Gout With Combined‐Type Hyperuricemia

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  • Media type: E-Article
  • Title: Superiority of Low‐Dose Benzbromarone Add‐On to Low‐Dose Febuxostat Compared With Febuxostat Monotherapy in Gout With Combined‐Type Hyperuricemia
  • Contributor: Xue, Xiaomei; Sun, Mingshu; Yan, Fei; Dalbeth, Nicola; He, Yuwei; Li, Xinde; Qi, Han; Chen, Ying; Yuan, Xuan; Li, Maichao; Ji, Aichang; Terkeltaub, Robert; Li, Changgui
  • imprint: Wiley, 2024
  • Published in: Arthritis Care & Research
  • Language: English
  • DOI: 10.1002/acr.25283
  • ISSN: 2151-464X; 2151-4658
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>Objective</jats:title><jats:p>There is an unmet need for simpler urate‐lowering therapy (ULT) regimens that achieve the serum urate target and improve the overall quality of gout care. We report a comparative effectiveness trial of febuxostat monotherapy versus benzbromarone add‐on to low‐dose febuxostat in gout specifically with combined renal urate underexcretion and overload.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A prospective randomized trial was conducted on patients with combined‐type hyperuricemia and estimated glomerular filtration rate &gt;60 mL/min/1.73 m<jats:sup>2</jats:sup> 1:1 randomly assigned 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 end point at 12 weeks was the proportion achieving a serum urate (SU) level &lt;360 μmol/L. Other outcomes included altered liver and kidney function, new‐onset urolithiasis, and gout flares.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There were 250 participants 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 [95% confidence interval 1.90–5.98]). Safety profiles were comparable between the two groups.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Simply adding on low‐dose benzbromarone (25 mg/day) to low‐dose (20 mg/day) febuxostat showed superior urate lowering compared to febuxostat monotherapy in gout with a 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.</jats:p></jats:sec>