Use of febuxostat to lower uric acid levels helped prevent cerebral, cardiovascular and renal events in elderly patients with hyperuricaemia based on findings from the FREED study presented Aug. 28 at ESC Congress 2018.

The study randomized 1,070 patients aged 65 years and older with hyperuricaemia to receive oral febuxostat for 36 months (N=537) or not (N=533). The febuxostat dose was increased stepwise from 10 to 40 mg per day if tolerated. In the non-febuxostat group, allopurinol (100 mg) was considered if serum uric acid was elevated. In both groups, doses of febuxostat or allopurinol were adjusted to avoid a serum uric acid level less than 2 mg/d. All patients were at higher risk for cerebral, cardiovascular or renal events based on risk factors such as hypertension, type 2 diabetes, renal disorder or a history of cerebral or cardiovascular disease, and were advised regarding diet, smoking, and exercise.

The primary endpoint – a composite of cerebral, cardiovascular, and renal events, and death from any cause – occurred in 125 patients (23 percent) in the febuxostat group compared with 153 patients (29 percent) in the non-febuxostat group. Researchers noted that febuxostat significantly reduced the rate of the primary endpoint, with a hazard ratio of 0.75.

Broken down by individual components, the most frequent event was renal impairment, which occurred in 16.2 percent of the febuxostat group and 20.5 percent of the non-febuxostat group. Non-fatal coronary artery disease and heart failure requiring hospitalization were both also lower in the febuxostat group compared with the non-febuxostat group (0.7 percent vs. 1.3 percent and 1.7 percent vs. 2.3 percent, respectively). However, febuxostat did not reduce major cerebrocardiovascular events (1.7 percent vs. 1.3 percent).

"We found that patients receiving febuxostat were 25 percent less likely to die or experience strokes, heart disease, or kidney disease over a three-year period than patients who did not receive febuxostat," said Professor Sunao Kojima, principal investigator, Kawasaki Medical School, Okayama, Japan. "The findings suggest that lowering uric acid with febuxostat provides clinical benefit."

Keywords: ESC18, ESC Congress, Gout Suppressants, Allopurinol

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