Lipid lowering drug has gout prevention benefit, FIELD trial reveals

The lipid-lowering drug fenofibrate could be a useful adjunctive treatment for preventing gout in patients with type 2 diabetes, an Australian trial has shown.

Use of fenobibrate reduced uric acid levels by 20% and almost halved incident gout events, a retrospective analysis of a trial involving almost 10,000 patients with type 2 diabetes  has found.

The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD study), randomised 9795 patients aged 50-75 to fenofibrate 200mg daily or placebo for with the primary aim of reducing lipid levels.

Analysis of gout outcomes among patients in the trial showed that those on active treatment showed an 20% reduction in plasma uric acid levels in the first six weeks of treatment compared with placebo, and the 20% reduction was maintained at one year of follow up.  The reduction corresponded to a reduction of 0.06mmol/L initially in uric acid levels.

Over the five year follow up of the trial, the rate of first gout events was 3% among the placebo group compared with 2% in the fenofibrate group (151 vs 81).

The cumulative proportion of gout attacks for patients with baseline uric acid levels higher than 0.36mmol/L was 7.7% in the placebo group and 3.4% in the fenofibrate group. For patients with uric acid levels higher than 0.42mmol/L the cumulative proportion of gout events was 13.9% for placebo and 5.7% for fenofibrate.

Reductions in uric acid levels were lower among patients taking allopurinol, with a 14% reduction initially and 10% reduction at one year, compared to placebo.

This observation could be a result of fenofibrate increasing excretion of the active metabolites of allopurinol, the study authors suggested, noting that similar smaller reductions in uric acid in patients on allopurinol have been reported with other uricosuric drugs including probenecid.

“Therefore, in patients already taking allopurinol, the reduction in plasma uric acid with fenofibrate appears similar to that with uricosuric drugs that have gout-specific indications,” they said.

Writing in Lancet Diabetes Endocrinology, the FIELD study researchers, from the NHMRC Clinical Trials Centre and Sydney Medical School, said the findings had confirmed 20% reduction in uric acid levels seen in smaller previous studies of fenofibrate.

“The most clinically relevant and important finding from these post-hoc analyses was that fenofibrate therapy almost halved the rate of incident episodes of acute gout. The event rates separated early and continued to diverge for the duration of the study,” they noted.

Since gout was common among people with type 2 diabetes, fenofibrate would be a useful adjunctive treatment that would prevent gout attacks as well as its effect on dyslipidaemia, they concluded.

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