In patients with chronic renal failure, treating gout and hyperuricemia might be problematic. There is no study comparing the efficacy of allopurinol, the most commonly used drug, and the uricosuric benzbromarone in treating hyperuricemia in individuals with renal insufficiency. Researchers described an open, randomised, active-controlled, comparative trial in individuals with creatinine clearances ranging from 20 to 80 mL/min/1.73 mL/min/1.73 mL/min/1.73 mL/min/1.73 mL/min/1.73 mL/min/1.73 m (2). Patients were given either benzbromarone (100-200 mg/day) or allopurinol (100-300 mg/day) as their treatment. Reduction of serum urate (Sur), Sur & tl; 6 mg/dL (357 micromol/L), reduction of gouty episodes, and reduction of tophi were the outcome variables. A total of 36 individuals were studied during 9 to 24 months of follow-up. Sur reduction was greater with benzbromarone, with just 1 of 17 patients receiving benzbromarone failing to attain Sur greater than 6 mg/dL compared to 7 of 19 patients using allopurinol. Patients who did not achieve ideal Sur levels with allopurinol were more likely to use diuretics, had lower fractional excretion of urate, and had greater beginning Sur levels than those who had good Sur management. 7 patients with inadequate serum urate control were switched to benzbromarone 100 mg/day, which had equivalent efficacy to those randomized to benzbromarone. After Sur was properly controlled, there was a reduction in gouty bouts and the size of tophi. Allopurinol is successful for treating hyperuricemia, but patients with higher starting Sur levels or who are on diuretic therapy at the same time are less likely to achieve therapeutic targets. Even with concurrent diuretic therapy, benzbromarone effectively controls hyperuricemia in patients with renal insufficiency; patients who previously had no improvement with allopurinol benefited.

 

Link:europepmc.org/article/med/19078356