Topiroxostat versus allopurinol in patients with chronic heart failure complicated by hyperuricemia: A prospective, randomized, open-label, blinded-end-point clinical trial.

Abstract

BACKGROUND:

The benefits of xanthine oxidase inhibitors to chronic heart failure (CHF) patients is controversial. We investigated the beneficial effects of a novel xanthine oxidoreductase inhibitor, topiroxostat, in patients with CHF and hyperuricemia (HU), in comparison to allopurinol.

METHODS AND RESULTS:

The prospective, randomized open-label, blinded-end-point study was performed in 141 patients with CHF and HU at 4 centers. Patients were randomly assigned to either topiroxostat or allopurinol group to achieve target uric acid level ≤6.0 mg/dL. According to the protocol, 140 patients were followed up for 24 weeks. Percent change in ln (N-terminal-proB-type natriuretic peptide) at week 24 (primary endpoint) was comparable between topiroxostat and allopurinol groups (1.6±8.2 versus -0.4±8.0%; P = 0.17). In the limited number of patients with heart failure with reduced ejection fraction (HFrEF) (left ventricle ejection fraction <45%), ratio of peak early diastolic flow velocity at mitral valve leaflet to early diastolic mitral annular motion velocity (E/e') decreased in topiroxostat group, but not in allopurinol group. Urinary 8-hydroxy-2'-deoxyguanosine and L-type fatty acid-binding protein levels increased and osmolality decreased significantly in allopurinol group, while these changes were less or absent in topiroxostat group. In allopurinol group HFrEF patients, additional to the increases in these urinary marker levels, urinary creatinine levels decreased, with no change in clearance, but not in topiroxostat group.

CONCLUSIONS:

Compared with allopurinol, topiroxostat did not show great benefits in patients with CHF and HU. However, topiroxostat might have potential advantages of reducing left ventricular end-diastolic pressure, not worsening oxidative stress in proximal renal tubule, and renoprotection over allopurinol in HFrEF patients.

• Authors: Masashi Sakuma, Shigeru Toyoda, Takuo Arikawa, Yota Koyabu, Toru Kato, Taichi Adachi, Hideaki Suwa, Jun-Ichi Narita, Koetsu Anraku, Kimihiko Ishimura, Fumitake Yamauchi, Yasunori Sato, Teruo Inoue
• Journal: PloS one (PLoS One) 2022 Vol. 17 Issue 1 Pg. e0261445 ISSN: 1932-6203 [Electronic] United States
• PMID: 35077456 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Biomarkers
• Nitriles
• Peptide Fragments
• Pyridines
• pro-brain natriuretic peptide (1-76)
• FYX-051
• Natriuretic Peptide, Brain
• Allopurinol

Topics

• Aged
• Aged, 80 and over
• Allopurinol (administration & dosage, therapeutic use)
• Biomarkers (urine)
• Female
• Heart Failure (complications, drug therapy, metabolism, physiopathology)
• Humans
• Hyperuricemia (drug therapy, etiology, metabolism, physiopathology)
• Male
• Middle Aged
• Natriuretic Peptide, Brain (metabolism)
• Nitriles (administration & dosage, therapeutic use)
• Peptide Fragments (metabolism)
• Prospective Studies
• Pyridines (administration & dosage, therapeutic use)
• Stroke Volume (drug effects)
• Treatment Outcome