Comparative cardiovascular risk in users versus non-users of xanthine oxidase inhibitors and febuxostat versus allopurinol users

Rheumatology (Oxford). 2020 Sep 1;59(9):2340-2349. doi: 10.1093/rheumatology/kez576.

Abstract

Objectives: The aim of this study is to determine major adverse cardiovascular events (MACE) and all-cause mortality comparing between xanthine oxidase inhibitors (XOIs) and non-XOI users, and between allopurinol and febuxostat.

Methods: This is a retrospective cohort study of gout patients prescribed anti-hyperuricemic medications between 2013 and 2017 using a territory-wide administrative database. XOI users were matched 1:1 to XOI non-users using propensity scores. Febuxostat users were matched 1:3 to allopurinol users. Subgroup analyses were conducted based on colchicine use.

Results: Of the 13 997 eligible participants, 3607 (25.8%) were XOI users and 10 390 (74.2%) were XOI non-users. After propensity score matching, compared with non-users (n = 3607), XOI users (n = 3607) showed similar incidence of MACE (hazard ratio [HR]: 0.997, 95% CI, 0.879, 1.131; P>0.05) and all-cause mortality (HR = 0.972, 95% CI 0.886, 1.065, P=0.539). Febuxostat (n = 276) users showed a similar risk of MACE compared with allopurinol users (n = 828; HR: 0.672, 95% CI, 0.416, 1.085; P=0.104) with a tendency towards a lower risk of heart failure-related hospitalizations (HR = 0.529, 95% CI 0.272, 1.029; P=0.061). Concurrent colchicine use reduced the risk for all-cause mortality amongst XOI users (HR = 0.671, 95% 0.586, 0.768; P<0.001).

Conclusion: In gout patients, XOI users showed similar risk of MACE and all-cause mortality compared with non-users. Compared with allopurinol users, febuxostat users showed similar MACE and all-cause mortality risks but lower heart failure-related hospitalizations.

Keywords: allopurinol; cardiovascular risk; febuxostat; gout; myocardial infarction; xanthine oxidase inhibitor.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Allopurinol / adverse effects*
  • Cardiovascular Diseases / chemically induced*
  • Enzyme Inhibitors / adverse effects*
  • Febuxostat / adverse effects*
  • Female
  • Gout / drug therapy
  • Gout Suppressants / adverse effects*
  • Heart Disease Risk Factors
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Xanthine Oxidase / antagonists & inhibitors*

Substances

  • Enzyme Inhibitors
  • Gout Suppressants
  • Febuxostat
  • Allopurinol
  • Xanthine Oxidase