Effect of Fenofibrate in Combination with Urate Lowering Agents in Patients with Gout

Abstract

BackgroundTo assess the efficacy of fenofibrate treatment in combination with urate lowering agents in patients with gout.MethodsFourteen male patients with chronic tophaceous or recurrent acute attacks of gout were evaluated in an open-label pilot study of the hypolipidemic agent, fenofibrate (Lipidil Supra® 160 mg/d). Patients were stable on urate lowering agents (allopurinol or benzbromarone) for ≥three months without acute attack for the most recent one month before participating. All patients were being treated with established doses of urate lowering agents without modification throughout the study. Clinical and biochemical assessments including serum uric acid, creatinine, liver function test and fasting serum lipid were measured at (1) baseline (2) after two months of fenofibrate treatment and (3) two months after fenofibrate was withdrawn.ResultsSerum uric acid was lowered by 23% after two months of fenofibrate treatment (6.93±2.16 vs. 5.22±1.16 mg/dL; p=0.016). Triglyceride levels were also reduced after fenofibrate treatment (p=0.001). However, this effect was reversed after the withdrawal (p=0.002) of the drug. Alkaline phosphatase was reduced after fenofibrate treatment (p=0.006), but increased 21% after the withdrawal of the drug (p=0.002). By contrast, serum levels of high density lipoprotein and creatinine were increased 9% (p=0.018) and 12% (p=0.006), respectively; however, both levels were significantly decreased to the baseline levels upon withdrawal of fenofibrate.ConclusionsFenofibrate can effectively reduce uric acid levels in addition to its known hypolipidemic effect. Fenofibrate may be used as a potential urate lowering agent in patients with gout, especially in those with coexisting hyperlipidemia.

Update on gout and hyperuricemia

“…Losartan, fenofibrate, statins, vitamin C and increased coffee intake have all been shown to modestly increase urine uric acid excretion (38)(39)(40)(41). There are currently no data in regard to the clinical utility of these interventions alone in the treatment of hyperuricemia and gout.…”

Management of Hyperuricemia and Gout

“…In general, feno fi brate has been shown to reduce serum uric acid to levels as low as 46 % in healthy volunteers, hypertensive, and diabetic patients as well as in gouty patients on speci fi c urate-lowering drugs. Feno fi brate also causes an increase in the renal clearance of urate in humans [ 766,813,815,829,837,838 ] . Feno fi brate at a dose of 150 mg three times a day increases the fractional clearance of xanthine, uric acid, and oxypurinol [ 839 ] .…”

New developments in clinically relevant mechanisms and treatment of hyperuricemia

“…In a recent short term study, the addition of 160 mg of fenofibrate as adjunctive to allopurinol or benzbromarone further decreased serum urate level by 20% [23]. Fenofibrate has been thought to be potentially attractive for use in carefully selected subjects with concomitant mild gout, mild hyperuricemia, and metabolic syndrome.…”