The quality of evidence is downgraded by imprecise results (few patients).
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).
| Outcome | Follow-up | Relative effect(95% CI) | Assumed risk - Allopurinol | Corresponding risk - Benzbromarone (95% CI) | Participants (studies) |
|---|---|---|---|---|---|
| Acute gout attacks | mean 4 months | RR 3.58(0.15 to 84.13) | 11 per 1000 | 40 per 1000(0 to 140) | 55(1 study) |
| Serum urate normalisation | 4-9 months | RR 1.27(0.9 to 1.79) | 600 per 1000 | 762 per 1000(540 to 1000) | 101(2 studies) |
| Withdrawal due to adverse events | median 4-9 months | RR 1.25(0.28 to 5.62) | 61 per 1000 | 77 per 1000(17 to 344) | 91(2 studies) |
| Total adverse events | mean 4 months | RR 3(0.64 to 14.16) | 67 per 1000 | 200 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.
| Outcome | Follow-up | Relative effect(95% CI) | Assumed risk - Allopurinol | Corresponding risk - Probenecid (95% CI) | Participants (studies) |
|---|---|---|---|---|---|
| Acute gout attacks | median 19.1 months | RR 0.96(0.53 to 1.75) | 550 per 1000 | 528 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.
| Outcome | Follow-up | Relative effect(95% CI) | Assumed risk - Probenecid | Corresponding risk - Benzbromarone (95% CI) | Participants (studies) |
|---|---|---|---|---|---|
| * HASH(0x2f830d0) 5 mg/dL (HASH(0x2f830d0) 0.3 mmol/L) | |||||
| Acute gout attacks | 2-3 months | RR 0.73(0.09 to 5.83) | 106 per 1000 | 77 per 1000(10 to 618) | 129(2 studies) |
| Serum urate normalisation* | mean 2 months | RR 1.43(1.02 to 2) | 571 per 1000 | 817 per 1000(583 to 1000) | 62(1 study) |
| Withdrawal due to adverse events | mean 2.5 months | RR 0.15(0.03 to 0.79) | 167 per 1000 | 25 per 1000(5 to 132) | 129(2 studies) |
| Total adverse events | mean 2.5 months | RR 0.43(0.25 to 0.74) | 470 per 1000 | 202 per 1000(117 to 348) | 129(2 studies) |
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