Comparison of cardiovascular risk between different antihyperuricaemic treatments

Takeaway

• In patients with gout, the risk for major adverse cardiovascular events (MACEs) and all-cause mortality did not differ between xanthine oxidase inhibitor (XOI) users and non-users.
• Febuxostat users showed similar MACEs and all-cause mortality risks compared with allopurinol users but lower risk for heart failure-related hospitalisations.

Why this matter

• Previous observational studies have shown a significant association between hyperuricaemia or gout and increased risk for cardiovascular (CV) morbidities.
• It is important to understand the CV effects of uric acid-lowering drugs to determine the treatment strategy that can reduce CV morbidity and mortality.

Study design

• Retrospective study of 13,997 patients with gout who received a prescription for antihyperuricaemic medications between 2013 and 2017.
• 3607 XOI users were matched 1:1 with XOI non-users and 276 febuxostat users were matched in 1:3 with allopurinol users using propensity scores (PS).
• Funding: None.

Key results

• After PS matching, risk for MACEs (HR, 0.997; 95% CI, 0.879-1.131; P=.962) and all-cause mortality (HR, 0.972; 95% CI, 0.886-1.065; P=.539) did not differ between XOI users vs non-users.
• Febuxostat vs allopurinol users did not differ in the risk for:
  • MACEs (HR, 0.672; 95% CI, 0.416-1.085; P=.104) and
  • all-cause mortality (HR, 0.985; 95% CI, 0.725-1.338; P=.921).
• Febuxostat reduced the risk for heart failure-related hospitalisations (HR, 0.529; 95% CI, 0.272-1.029; P=.061).
• In XOI users, concurrent colchicine users were at lower risk for all-cause mortality (HR, 0.671; 95% CI, 0.586-0.768; P<.001).

Limitations

• Retrospective design.
• Study did not collect data on patients’ lifestyle and socioeconomic status.