Cardiovascular risk associated with allopurinol vs. benzbromarone in patients with gout.

Abstract

AIMS:

With the high prevalence of gout and associated cardiovascular (CV) diseases, information on the comparative CV safety of individual urate-lowering drugs becomes increasingly important. However, few studies examined the CV risk of uricosuric agents. We compared CV risk among patients with gout who initiated allopurinol vs. benzbromarone.

METHODS AND RESULTS:

Using the Korean National Health Insurance claims data (2002-17), we conducted a cohort study of 124 434 gout patients who initiated either allopurinol (n = 103 695) or benzbromarone (n = 20 739), matched on propensity score at a 5:1 ratio. The primary outcome was a composite CV endpoint of myocardial infarction, stroke/transient ischaemic attack, or coronary revascularization. To account for competing risk of death, we used cause-specific hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes comparing allopurinol initiators with benzbromarone. Over a mean follow-up of 1.16 years, 2258 patients developed a composite CV event. The incidence rate of the composite CV event was higher in allopurinol initiators (1.81 per 100 person-years) than benzbromarone (1.61 per 100 person-years) with a HR of 1.22 (95% CI 1.05-1.41). The HR for all-cause mortality was 1.66 (95% CI 1.43-1.93) among allopurinol initiators compared with benzbromarone.

CONCLUSION:

In this large population-based cohort of gout patients, allopurinol was associated with an increased risk of composite CV events and all-cause mortality compared to benzbromarone. Benzbromarone may reduce CV risk and mortality in patients with gout, although more studies are necessary to confirm our findings and to advance our understanding of the underlying mechanisms.

• Authors: Eun Ha Kang, Eun Hye Park, Anna Shin, Jung Soo Song, Seoyoung C Kim
• Journal: European heart journal (Eur Heart J) Vol. 42 Issue 44 Pg. 4578-4588 (11 21 2021) ISSN: 1522-9645 [Electronic] England
• PMID: 34508567 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Chemical References

• Gout Suppressants
• Benzbromarone
• Allopurinol

Topics

• Allopurinol (adverse effects)
• Benzbromarone (adverse effects)
• Cardiovascular Diseases (drug therapy, epidemiology, prevention & control)
• Cohort Studies
• Gout (drug therapy, epidemiology)
• Gout Suppressants (adverse effects)
• Heart Disease Risk Factors
• Humans
• Risk Factors