Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout.
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of once-daily therapy with micronized fenofibrate (Lipantil Micro) at 200 mg and (iii) 3 weeks after fenofibrate was withdrawn.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.
Feher
M D
MD
Lipid Clinic, London SW10 9NH, UK. m.feher@chelwest.nhs.uk
Hepburn
A L
AL
Hogarth
M B
MB
Ball
S G
SG
Kaye
S A
SA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000493:Allopurinol / Q000627:therapeutic use*; D015210:Arthritis, Gouty / Q000517:prevention & control; D002908:Chronic Disease; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D011345:Fenofibrate / Q000627:therapeutic use*; D006073:Gout / Q000378:metabolism / Q000517:prevention & control*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy* / Q000378:metabolism; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014527:Uric Acid / Q000378:metabolism
D006074:Gout Suppressants; D000960:Hypolipidemic Agents; D008055:Lipids; D014527:Uric Acid; D000493:Allopurinol; D000469:Alkaline Phosphatase; D011345:Fenofibrate