Cardiovascular Risk and Gout Treatment: Febuxostat v. Allopurinol Interview with:
“Gout in my foot” by vagawi  is licensed under CC BY 2.0Seoyoung C. Kim, MD, ScD, MSCE
Associate Professor of Medicine
Division of Pharmacoepidemiology & Pharmacoeconomics
Division of Rheumatology, Immunology and Allergy
Brigham and Women’s Hospital, Harvard Medical School What is the background for this study? What are the main findings? 

Response: Since patients with gout are at an increased risk of cardiovascular events, we wanted to examine comparative cardiovascular safety of the two most commonly used urate-lowering drugs – febuxostat and allopurinol.

Using claims data from US Medicare, we conducted a cohort study of 24,936 febuxostat initiators PS-matched to 74,808 allopurinol initiators.

We found the risk of the primary cardiovascular endpoint (MI or stroke) was similar between the two groups. Analyses on secondary endpoints as well as all-cause mortality showed similar findings except that febuxostat was associated with a modestly reduced risk of heart failure exacerbation among patients with preexisting heart failure. In our sensitivity analysis, the risk of all-cause mortality associated with long-term use of febuxostat v. allopurinol appears to be increased but statistically not significant. What should readers take away from your report?

Response: In this large population based cohort of older patients with gout, the overall cardiovascular risk is similar between febuxostat and allopurinol initiators. What recommendations do you have for future research as a result of this work? 

Response: Given the CARES data and our results, a larger study with longer duration of followup may be able to determine the long-term effect of febuxostat v. allopurinol on the risk of all-cause death.   

Disclosures: This study was supported by internal funding from the Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women’s Hospital and Harvard Medical School.


Assessment of Cardiovascular Risk in Older Patients with Gout Initiating Febuxostat versus Allopurinol: A Population-Based Cohort Study

MaryAnn Zhang, Daniel H. Solomon, Rishi J. Desai, Eun Ha Kang, Jun Liu, Tuhina Neogi, Seoyoung C. Kim

Circulation. 2018;CIRCULATIONAHA.118.033992

Originally published June 13, 2018




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Last Updated on June 18, 2018 by Marie Benz MD FAAD