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Evidence summaries

Uricosuric Medications for Chronic Gout

Benzbromarone appears to reduce uric acid levels to a similar degree than allopurinol in patients with chronic gout. Level of evidence: "B"

The quality of evidence is downgraded by imprecise results (few patients).

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 274 subjects. Most participants were male, aged between 50 and 70 years and did not have significant kidney or liver disease. Two studies compared benzbromarone with allopurinol, 2 compared benzbromarone with probenecid and 1 study compared allopurinol with probenecid. No studies comparing uricosuric medications with placebo, or with newer urate-lowering therapies such as febuxostat or pegloticase, were found.

There were no statistically significant differences in acute gout attacks, serum urate normalisation, or adverse events between benzbromarone and allopurinol (table T1).

Benzbromarone compared with allopurinol for chronic gout

OutcomeFollow-upRelative effect(95% CI)Assumed risk - AllopurinolCorresponding risk - Benzbromarone (95% CI)Participants (studies)
Acute gout attacksmean 4 monthsRR 3.58(0.15 to 84.13)11 per 100040 per 1000(0 to 140)55(1 study)
Serum urate normalisation4-9 monthsRR 1.27(0.9 to 1.79)600 per 1000762 per 1000(540 to 1000)101(2 studies)
Withdrawal due to adverse eventsmedian 4-9 monthsRR 1.25(0.28 to 5.62)61 per 100077 per 1000(17 to 344)91(2 studies)
Total adverse eventsmean 4 monthsRR 3(0.64 to 14.16)67 per 1000200 per 1000(43 to 944)55(1 study)

No difference in acute gout attacks between probenecid and allopurinol (table T2) was observed. The study did not measure or report the proportion achieving serum urate normalisation, pain reduction, function, tophus regression, withdrawal due to adverse events and total adverse events.

Probenecid compared with allopurinol for chronic gout

OutcomeFollow-upRelative effect(95% CI)Assumed risk - AllopurinolCorresponding risk - Probenecid (95% CI)Participants (studies)
Acute gout attacksmedian 19.1 monthsRR 0.96(0.53 to 1.75)550 per 1000528 per 1000(291 to 962)37(1 study)

Participants taking benzbromarone were more likely to achieve serum urate normalisation after 2 months than those taking probenecid (table T3; NNTB 5). However, another study reported no difference in the absolute decrease in serum urate between these groups after 12 weeks. No statistically significant difference was observed in acute gout attacks. There were fewer withdrawals due to adverse (NNTB 7) events and fewer total adverse events (NNTB 4) with benzbromarone compared with probenecid.

Benzbromarone compared with probenecid for chronic gout

OutcomeFollow-upRelative effect(95% CI)Assumed risk - ProbenecidCorresponding risk - Benzbromarone (95% CI)Participants (studies)
* HASH(0x2fd0288) 5 mg/dL (HASH(0x2fd0288) 0.3 mmol/L)
Acute gout attacks2-3 monthsRR 0.73(0.09 to 5.83)106 per 100077 per 1000(10 to 618)129(2 studies)
Serum urate normalisation*mean 2 monthsRR 1.43(1.02 to 2)571 per 1000817 per 1000(583 to 1000)62(1 study)
Withdrawal due to adverse eventsmean 2.5 monthsRR 0.15(0.03 to 0.79)167 per 100025 per 1000(5 to 132)129(2 studies)
Total adverse eventsmean 2.5 monthsRR 0.43(0.25 to 0.74)470 per 1000202 per 1000(117 to 348)129(2 studies)

Clinical comments

Note

Date of latest search:

    References

    • Kydd AS, Seth R, Buchbinder R et al. Uricosuric medications for chronic gout. Cochrane Database Syst Rev 2014;(11):CD010457. [PubMed]

Primary/Secondary Keywords