my personal edition > arthritis other > news


  E-Mail this DGReview to a colleague

DGReview

Fenofibrate, Losartan Show Additive Benefits with Anti-hyperuricaemic Agents in Gout Patients

Anti-hyperuricaemic agents supplemented with either fenofibrate to reduce triglyceride levels, or losartan to reduce blood pressure, also further decreases uric acid levels in gout patients.

Over 50% of patients with gout also experience hypertriglyceridaemia and hypertension. Treatments are available for each of these serious morbidities, although studies analysing the combinatorial effects of these treatments are lacking.

Some studies have reported that fenofibrateand losartan can also decrease serum uric acid levels by increasing the renal clearance of uric acid. The addition of these drugs to ongoing anti-hyperuricaemic treatment in gout patients with hypertriglyceridaemia or hypertension, therefore, show promise for the concomitant treatment of each morbidity.

Yuji Moriwaki, MD, and colleagues at the Hyogo College of Medicine, Japan, evaluated the effects on uric acid metabolism of a combinatorial treatment of anti-hyperuricaemic agents with either fenofibrate in this group of patients.

Twenty-seven males (average age 50) with gout and hypertriglyceridaemia were given 300 mg of fenofibrate once daily for 2 months and were simultaneously treated with 50 mg benzbromarone once daily for those with underexcretory gout or with 200 mg allopurinol twice daily for those with overexcretory gout.

In the hypertension study, 25 males (average age 54) with gout and hypertension were administered 50 mg losartan daily for 2 months in conjunction with the same anti-hyperuricaemic treatment described for the hypertriglyceridaemia study.

Fenofibrate was successful in decreasing the serum levels of triglycerides in both the benzbromarone and allopurinol groups. However, total cholesterol levels only showed a significant decrease in the allopurinol-fenofibrate group and neither group showed changes in HDL-cholesterol levels.

Losartan treatment resulted in decreased systolic and diastolic blood pressure in both anti-hyperuricaemic treatment arms, but did not alter creatinine clearance. Specifically, the benzbromarone-losartan group decreased from 160/101 mm Hg to 137/83 mm HG and the allopurinol-losartan group decreased from 161/101 mm Hg to 129/80 mm Hg.

Furthermore, all study groups showed significant decreases in serum uric acid upon supplementation of anti-hyperuricaemic agent with either losartan or fenofibrate treatment, which was most likely due to increased uric acid clearance and urinary excretion.

Dr. Moriwaki concludes that these results demonstrate "an additive uric acid lowering effect of fenofibrate and/or losartan in hypertriglyceridaemic and/or hypertensive patients with gout who were receiving anti-hyperuricaemic agents." Therefore, the "combination of fenofibrate or losartan with anti-hyperuricaemic agents is a good option for the treatment of gout patients with hypertriglyceridaemia and/or hypertension."
Ann Rheum Dis Vol 62, Issue 6 (June), 2003:572-575. "Effects of combination treatment using anti-hyperuricaemic agents with fenofibrate and/or losartan on uric acid metabolism"

E-Mail this DGReview to a colleague

To print, use this version