Fenofibrate produces large gout risk reduction in diabetes patients
medwireNews: The anti-cholesterol medication fenofibrate significantly reduces uric acid levels and more than halves the risk for gout in patients with type 2 diabetes, shows an analysis of the FIELD cohort.
The FIELD trial tested fenofibrate in diabetes patients with dyslipidemia, showing some evidence of a cardioprotective effect (significant reductions in non-fatal myocardial infarction and coronary revascularization) despite missing its primary endpoint.
At baseline, the average uric acid level in the 9623 patients with sufficient plasma sample to allow its measurement was around 0.32 mmol/L, and 11% of patients were hyperuricemic, with uric acid levels greater than 0.42 mmol/L. Among the 1948 participants who had uric acid measurements at both baseline and after 1 year, levels fell by a significant 20% in those taking fenofibrate versus placebo.
During the full median 5 years of treatment, 232 patients had at least one episode of gout, but rates were significantly lower among those taking fenofibrate than placebo, at 1.7% versus 3.1%. The corresponding rates among those with hyperuricemia at baseline were 5.7% and 13.9%.
“The event rates separated early and continued to diverge for the duration of the study,” write Anthony Keech (University of Sydney, New South Wales, Australia) and co-researchers in The Lancet Diabetes & Endocrinology.
They note that gout is increasingly common in diabetes patients, but preventive treatment requires an increased number of medications, “with implications for adherence, side-effects, and interactions.”
Therefore, fenofibrate, “which has indications for diabetic dyslipidaemia and retinopathy,” could represent a convenient single approach to tackling two problems, they suggest.
The effect of fenofibrate on gout risk persisted after accounting for factors including age, BMI, baseline uric acid level, and allopurinol use, at a 54% reduction. The effect of fenofibrate treatment was lessened in patients taking allopurinol – unless allopurinol did not reduce uric acid levels. Conversely, fenofibrate had a significantly larger effect in patients with hyperuricemia than in those with normal uric acid levels.
Keech and team observe that the FIELD study cohort was large and recruited more than 70% of patients who were screened for the study, making it “reasonably representative of type 2 diabetes in the community,” and “thus increasing the applicability of the results to the primary care practitioner.”
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