PT  - JOURNAL ARTICLE
AU  - Irene A. van Echteld
AU  - Caroline van Durme
AU  - Louise Falzon
AU  - Robert B. Landewé
AU  - Désirée M. van der Heijde
AU  - Daniel Aletaha
TI  - Treatment of Gout Patients with Impairment of Renal Function: A Systematic Literature Review
AID  - 10.3899/jrheum.140462
DP  - 2014 Sep 01
TA  - The Journal of Rheumatology
PG  - 48--54
VI  - 92
4099  - http://www.jrheum.org/content/92/48.short
4100  - http://www.jrheum.org/content/92/48.full
SO  - J Rheumatol2014 Sep 01; 92
AB  - Objective. To assess the efficacy and safety of gout-specific medications in gout patients with a comorbidity and/or comedication. Methods. A systematic literature search for gout, its medication, and the most common comorbidities and comedications, using serum uric acid (SUA) levels as the primary, and adverse events as the secondary outcomes. Results. Eight trials met inclusion criteria. Trials covered treatment with allopurinol, benzbromarone, rasburicase, or febuxostat in a gout population with mild or moderate renal insufficiency. High risk of bias (5/8 trials) and heterogeneity precluded formal metaanalysis. The trials showed the following hierarchy in efficacy (lowering the SUA below 6.0 mg/dl): febuxostat 80 mg (44%–71%) > febuxostat 40 mg (43%–52%) > allopurinol 100 mg or 200 mg (0–46%) after 6 months of therapy; rasburicase (46%) > allopurinol 300 mg (16%) after 7 days of therapy; benzbromarone 100–200 mg (93%) > allopurinol 100–200 mg (63%) after 9–24 months of therapy. The combination of allopurinol and benzbromarone seemed to be effective, with a significant reduction in the SUA from 7.8 to 5.7 mg/dl (p < 0.05) after 1 month. One study showed that 89% achieved the target SUA using higher doses of allopurinol than usually recommended for patients with renal impairment without an apparent increase in adverse events. In addition, allopurinol and benzbromarone significantly improved renal function. Conclusion. In gout patients with renal insufficiency febuxostat, rasburicase, benzbromarone, and allopurinol + benzbromarone seemed to be effective and safe; allopurinol may be cautiously titrated until the target uric acid level has been reached, and may improve renal function.