Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout

Rheumatology (Oxford). 2003 Feb;42(2):321-5. doi: 10.1093/rheumatology/keg103.

Abstract

Objective: To assess the short-term urate-lowering effect of fenofibrate in men on long-term allopurinol therapy for hyperuricaemia and gout.

Methods: Ten male patients (38-74 yr) with a history of chronic tophaceous or recurrent acute gout with hyperuricaemia and on established allopurinol at 300-900 mg/day for > or =3 months were studied in an open-crossover study of fenofibrate therapy. Allopurinol at the established dose was continued throughout the study. Clinical and biochemical assessments (serum urate and creatinine, 24-h urinary excretion of urate and creatinine, liver function tests, creatine kinase and fasting serum lipids) were undertaken at: (i) baseline, (ii) after 3 weeks of once-daily therapy with micronized fenofibrate (Lipantil Micro) at 200 mg and (iii) 3 weeks after fenofibrate was withdrawn.

Results: Fenofibrate was associated with a 19% reduction in serum urate after 3 weeks of treatment (mean+/-S.E. 0.37+/-0.04 vs 0.30+/-0.02 mM/l; P=0.004). The effect was reversed after a 3-week fenofibrate withdrawal period (0.30+/-0.02 vs 0.38+/-0.03 mM/l). There was a rise in uric acid clearance with fenofibrate treatment of 36% (7.2+/-0.9 vs 11.4+/-1.6 ml/min, normal range 6-11; P=0.006) without a significant change in creatinine clearance. Both total cholesterol and serum triglycerides were also reduced. No patient developed acute gout whilst taking fenofibrate.

Conclusions: Fenofibrate has a rapid and reversible urate-lowering effect in patients with hyperuricaemia and gout on established allopurinol prophylaxis. Fenofibrate may be a potential new treatment for hyperuricaemia and the prevention of gout, particularly in patients with coexisting hyperlipidaemia or those resistant to conventional therapy for hyperuricaemia.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Alkaline Phosphatase / blood
  • Allopurinol / therapeutic use*
  • Arthritis, Gouty / prevention & control
  • Chronic Disease
  • Cross-Over Studies
  • Drug Therapy, Combination
  • Fenofibrate / therapeutic use*
  • Gout / metabolism
  • Gout / prevention & control*
  • Gout Suppressants / therapeutic use*
  • Humans
  • Hyperuricemia / drug therapy*
  • Hyperuricemia / metabolism
  • Hypolipidemic Agents / therapeutic use
  • Lipids / blood
  • Male
  • Middle Aged
  • Recurrence
  • Uric Acid / metabolism

Substances

  • Gout Suppressants
  • Hypolipidemic Agents
  • Lipids
  • Uric Acid
  • Allopurinol
  • Alkaline Phosphatase
  • Fenofibrate