Pierre-Antoine Juge1, Marie-Elise Truchetet2, Evangeline Pillebout3, Sébastien Ottaviani4, Cécile Vigneau5, Clotilde Loustau2, Divi Cornec6, Tristan Pascart7, Renaud Snanoudj8, Florian Bailly9, Emilie Cornec-Le Gall10, Thierry Schaeverbeke2, Alain Saraux6, Philippe Dieudé4, René-Marc Flipo11, Pascal Richette1, Frédéric Lioté1, Thomas Bardin1, Gérard Chalès12, Hang-Korng Ea13. 1. Service de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France. 2. Service de rhumatologie, CHU de Bordeaux, groupe hospitalier Pellegrin, 33000 Bordeaux, France. 3. Service de néphrologie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 75010 Paris, France. 4. Service de rhumatologie, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 75018 Paris, France. 5. Service de néphrologie, hôpital Pontchaillou, 35033 Rennes cedex, France. 6. Service de rhumatologie, hôpital universitaire de Brest, 29200 Brest, France. 7. Service de rhumatologie, hôpital Saint-Philibert, 59160 Lille, France. 8. Service de néphrologie, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 75015 Paris, France. 9. Service de rhumatologie, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Assistance publique-Hôpitaux de Paris, 75013 Paris, France. 10. Service de néphrologie, CHRU de Brest, 29200 Brest, France. 11. Service de rhumatologie, CHU Roger-Salengro, 59160 Lille, France. 12. Service de rhumatologie, CHU de Rennes, 35033 Rennes cedex, France. 13. Service de rhumatologie, centre Viggo-Petersen, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 75010 Paris, France; Inserm UMR 1132, université Paris Diderot, Sorbonne Paris Cité, 75475 Paris cedex 10, France. Electronic address: korngea@yahoo.fr.
Abstract
OBJECTIVES: The allopurinol dose is limited in chronic kidney disease, particularly stage 4/5 chronic kidney disease. Febuxostat has a hepatic metabolism and has been approved without dose adaptation in gouty patients with stage 1-3 chronic kidney disease. We aimed to study the safety and efficacy of febuxostat for stage 4/5 chronic kidney disease. METHODS: In this retrospective study, we included patients with (1) a diagnosis of gout, (2) febuxostat treatment, (3) estimated glomerular filtration rate≤30mL/min/1.73m2 (Modification of Diet in Renal Disease formula) at febuxostat initiation and (4) follow-up for at least 3 months after febuxostat initiation. Efficacy, safety and variation in estimated glomerular filtration rate were analyzed. RESULTS: We included 73 patients (mean age 70.2±11.8, 61 men, 31 with vascular chronic kidney disease and 18 renal transplantation) with gout (baseline serum uric acid level=9.86±2.85mg/dL, mean gout duration 6.2±7.0 years) from 10 academic centers. Comorbidities included cardiac failure (17.8%), hypertension (98.6%), diabetes mellitus (30.1%), dyslipidemia (64.8%) and history of cardiovascular events (38.4%). At the last visit (mean follow-up 68.5±64.8 weeks), the daily dose of febuxostat was 40mg for 7 patients (10.5%), 80mg for 50 (74.6%) and 120mg for 10 (14.9%). Serum uric acid level was<6mg/dL for 49 patients (67%). Renal function improved for 18 patients, was unchanged for 24 and worsened for 31; 19 patients experienced flares and 1 patient, limb edema. CONCLUSION: Febuxostat seemed efficient in gouty patients with stage 4/5 chronic kidney disease. However, safety data were not clear regarding renal function. Larger studies are needed to assess safety.
OBJECTIVES: The allopurinol dose is limited in chronic kidney disease, particularly stage 4/5 chronic kidney disease. Febuxostat has a hepatic metabolism and has been approved without dose adaptation in gouty patients with stage 1-3 chronic kidney disease. We aimed to study the safety and efficacy of febuxostat for stage 4/5 chronic kidney disease. METHODS: In this retrospective study, we included patients with (1) a diagnosis of gout, (2) febuxostat treatment, (3) estimated glomerular filtration rate≤30mL/min/1.73m2 (Modification of Diet in Renal Disease formula) at febuxostat initiation and (4) follow-up for at least 3 months after febuxostat initiation. Efficacy, safety and variation in estimated glomerular filtration rate were analyzed. RESULTS: We included 73 patients (mean age 70.2±11.8, 61 men, 31 with vascular chronic kidney disease and 18 renal transplantation) with gout (baseline serum uric acid level=9.86±2.85mg/dL, mean gout duration 6.2±7.0 years) from 10 academic centers. Comorbidities included cardiac failure (17.8%), hypertension (98.6%), diabetes mellitus (30.1%), dyslipidemia (64.8%) and history of cardiovascular events (38.4%). At the last visit (mean follow-up 68.5±64.8 weeks), the daily dose of febuxostat was 40mg for 7 patients (10.5%), 80mg for 50 (74.6%) and 120mg for 10 (14.9%). Serum uric acid level was<6mg/dL for 49 patients (67%). Renal function improved for 18 patients, was unchanged for 24 and worsened for 31; 19 patients experienced flares and 1 patient, limb edema. CONCLUSION:Febuxostat seemed efficient in gouty patients with stage 4/5 chronic kidney disease. However, safety data were not clear regarding renal function. Larger studies are needed to assess safety.
Authors: Hamish Farquhar; Ana B Vargas-Santos; Huai Leng Pisaniello; Mark Fisher; Catherine Hill; Angelo L Gaffo; Lisa K Stamp Journal: Rheumatol Adv Pract Date: 2021-01-04