Benzbromarone Provides More Rapid Gout Benefit than Febuxostat

Febuxostat provides long-term effects on the liver and kidney as benzbromarone in the treatment of patients with gout and hyperuricemia, according to new data from a meta-analysis that which also showed benzbromarone may be a more rapidly effective therapy for reducing serum acid levels and inflammation.

In new findings from a team of China investigators, a comparison between urate-lowering therapies (ULTs) febuxostat and benzbromarone elucidated disparities in timing of efficacy and disease-specific outcomes among patients with hyperuricemia and gout. The findings may help inform treatment strategies for clinicians based on their desired outcome for specific patients with the rheumatic condition.

Led by Fan Wu, of the School of Pharmaceutical Sciences at South-Central Minzu University, investigators conducted an analysis to address gaps of knowledge in prescribing-relevant strategy for the 2 agents—one representing the old guard of gout treatment, the other representing a new guard.

“ULT is widely recognized as the primary treatment for hyperuricemia and gout,” Wu and colleagues wrote. “Xanthine oxidase inhibitors (XOI), particularly febuxostat, have gained popularity as a frontline approach. However, the divergent efficacy and safety between febuxostat and the traditional ULT drug, benzbromarone, remain poorly understood.”

Similar efforts to interpret discrepancies between febuxostat and benzbromarone in the treatment of gout have been recently published. Another international study from earlier this year suggested benzbromarone provided a greater reduction in uric acid with less hepatotoxicity, while febuxostat significantly improved measures of renal function in patients with gout.

In this newest analysis, Wu and colleagues conducted a systematic analysis across 4 medical literature databases. They used each of forest plots, funnel plots, sensitivity analysis, Egger’s test, and subgroup analyses to compare relevant indicators of treatment efficacy between febuxostat and benzbromarone.

The identified and clinical relevant indicators of treatment efficacy by which investigators compared the 2 drugs included: SUA; triglyceride; urinary uric acid; white blood cell count; total cholesterol; blood urea nitrogen; alanine aminotransferase (ALT); aspartate aminotransferase (AST); estimated glomerular filtration rate (eGFR); and serum creatine.

The team observed that benzbromarone was associated with greater efficacy as per rapid reduction of SUA levels and inhibited inflammation for hyperuricemia and gout patients. Meanwhile, febuxostat was slightly less superior in lowering patient SUA, but provided clinically similar effects on liver and kidney function as benzbromarone in treated patients during long-term use.

Investigators concluded their contribution to comparison of newer and more common ULT therapies “goes beyond previous research” in its analysis.

“Benzbromarone stands out as a highly effective treatment for hyperuricemia and gout, offering rapid reduction of serum uric acid levels and potent anti-inflammatory effects,” the team wrote. “When it comes to long-term use, febuxostat demonstrates comparable effects on liver and kidney function. This provides reassurance for patients who require extended treatment duration.”

References

1. ^{Wu F, Chen L, Du Y. Comparison of the efficacy and safety of benzbromarone and febuxostat in gout and hyperuricemia: a systematic review and meta-analysis. Clin Rheumatol. Published online March 16, 2024. doi:10.1007/s10067-024-06933-4}
2. ^{Pine L. Study Compares Clinical Efficacy of Febuxostat, Benzbromarone in Gout Treatment. HCPLive. Published January 14, 2024. https://www.hcplive.com/view/study-compares-clinical-efficacy-of-febuxostat-benzbromarone-in-gout-treatment}