title: The safety and efficacy of benzbromarone in gout in Aotearoa New Zealand.
abstract: BACKGROUND
  Benzbromarone is a potent uricosuric but is not widely available due to concerns about hepatotoxicity. In Aotearoa New Zealand, benzbromarone has been available since April 2013, subject to funding restrictions, for patients with inadequate urate-lowering response or intolerance to allopurinol and probenecid.
  
  
  OBJECTIVE
  To assess the safety and efficacy of benzbromarone in a real-life setting.
  
  
  METHODS
  All patients who received funding for benzbromarone from 1 April 2013 to 30 September 2014 were identified. Prescribers were sent a questionnaire for each individual. Information on demographics, efficacy of previous urate-lowering drugs and reasons for discontinuation were collected. Specific information about the dose, effect on serum urate, adverse effects and liver function tests after commencing benzbromarone was recorded.
  
  
  RESULTS
  Completed questionnaires were returned for 123 of 164 (75%) patients. Mean (SD) serum urate prior to benzbromarone was 0.57 (0.12) mmol/L, and estimated glomerular filtration rate was 50.3 (22.8) mL/min/1.73 m(2) . The median dose of benzbromarone was 100 mg/day (25-200 mg/day). Six months after commencing benzbromarone, mean (SD) serum urate was 0.35 (0.12) mmol/L. Benzbromarone-related adverse events included rash (n = 4), diarrhoea (n = 9), nausea (n = 6) and urate stones (n = 3). Liver function test abnormalities were uncommon and tended to be mild. There were 14 patient deaths; none was considered related to benzbromarone. Allopurinol had been prescribed prior to benzbromarone in 117 of 123 patients; median maximum allopurinol dose was 200 mg/day (range 25-600 mg/day), and 19% patients received allopurinol >300 mg/day.
  
  
  CONCLUSIONS
  Benzbromarone provides useful urate-lowering efficacy and does not appear unsafe in patients with gout. Urate-lowering therapy prescribing requires further optimisation.
authors.affiliation: Deparment of Medicine, University of Otago, Christchurch, New Zealand. lisa.stamp@cdhb.health.nz.
authors.forename: L K
authors.initials: LK
authors.lastname: Stamp
authors.affiliation: Deparment of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Haslett
authors.affiliation: Deparment of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Frampton
authors.affiliation: Department of Rheumatology, Waikato Hospital, Hamilton, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: White
authors.affiliation: Department of Rheumatology, Hawkes Bay DHB, Napier, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Gardner
authors.affiliation: Department of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: S
authors.initials: S
authors.lastname: Stebbings
authors.affiliation: Department of Rheumatology, Whanganui Hospital, Whanganui, New Zealand.
authors.forename: G
authors.initials: G
authors.lastname: Taylor
authors.affiliation: Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Grainger
authors.affiliation: Department of Rheumatology, Taranaki Hospital, New Plymouth, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Deparment of Rheumatology, Tauranga Hospital, Tauranga, New Zealand.
authors.forename: T
authors.initials: T
authors.lastname: Kain
authors.affiliation: Nelson Hospital, Nelson, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Porter
authors.affiliation: North Shore Hospital, Auckland, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Corkill
authors.affiliation: Pharmaceutical Management Agency (PHARMAC), Wellington, New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Cathro
authors.affiliation: Pharmaceutical Management Agency (PHARMAC), Wellington, New Zealand.
authors.forename: S
authors.initials: S
authors.lastname: Metcalfe
authors.affiliation: Pharmaceutical Management Agency (PHARMAC), Wellington, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Wyeth
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: N
authors.initials: N
authors.lastname: Dalbeth
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use; D001553:Benzbromarone / Q000008:administration & dosage* / Q000009:adverse effects; D015897:Comorbidity; D005076:Exanthema / Q000209:etiology; D005260:Female; D006073:Gout / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D012189:Retrospective Studies; D014527:Uric Acid / Q000097:blood; D014528:Uricosuric Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D006074:Gout Suppressants; D014528:Uricosuric Agents; D014527:Uric Acid; D001553:Benzbromarone; D000493:Allopurinol
keywords: benzbromarone; gout; urate-lowering therapy