Diabetes and gout: efficacy and safety of febuxostat and allopurinol

AimAssess influences of demographics and co-morbidities of gout patients with or without diabetes on safety and efficacy of urate-lowering agents. MethodsPost-hoc analysis of 312 diabetic and 1957 non-diabetic gout patients [baseline serum urate levels (sUA) 8.0mg/dl] enrolled in a 6-month randomized controlled trial comparing urate-lowering efficacy (ULE) and safety of daily xanthine oxidase inhibitors (XOIs) febuxostat (40mg or 80mg) and allopurinol (200mg or 300mg). We compared baseline demographic, gout and co-morbid characteristics, ULE, and safety of XOI treatment in diabetic and non-diabetic gout patients. ULE was measured by the proportion of diabetic and non-diabetic patients in each treatment group achieving final visit sUA<6.0mg/dl. Safety was monitored throughout the trial. ResultsDiabetic gout patients were older, more frequently female, and had longer gout duration. Co-morbidities were more frequent among diabetic patients: cardiovascular disease; impaired renal function; hyperlipidemia; and obesity (body mass index >30kg/m(2)) (p<0.001 for all comparisons). Febuxostat 80mg ULE exceeded that of febuxostat 40mg or allopurinol (p<0.050) at all levels of renal function, achieving sUA goal range in the majority of diabetic and non-diabetic patients. Diabetics and non-diabetics reported self-limiting diarrhoea and URIs as the most common adverse events. ConclusionsDespite higher co-morbidity rates in diabetic patients, febuxostat and allopurinol were safe in both groups at the doses tested. Febuxostat 80mg achieved sUA <6.0mg/dl more often than febuxostat 40mg or allopurinol at commonly prescribed doses.