Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study

Waldman, Boris; Ansquer, Jean-Claude; Sullivan, David; Jenkins, Alicia J.; McGill, Neil; Buizen, Luke; Davis, Timothy; Best, James D.; Li, Liping; Feher, Michael; Foucher, Christelle; Kesäniemi, Y. Antero; Flack, J.; d’Emden, Michael C; Scott, Russell S.; Hedley, J. M.; Gebski, Val; Keech, Anthony

doi:10.1016/s2213-8587(18)30029-9

Cited by 48 publications

(32 citation statements)

References 32 publications

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“…Likewise, the Voting Panel specifically recommended against adding or switching cholesterol‐lowering agents (e.g., statins, bile acid sequestrants, nicotinic acid agents, etc.) to fenofibrate despite its urate‐lowering effects , as the risks, including side effects of the medication, were felt to outweigh potential benefits. Although likely to render only modest urate‐lowering effects, switching from an angiotensin‐converting enzyme inhibitor to losartan carries a risk that seems to be sufficiently low in most patients to merit this change when feasible (for all recommendations for management of concurrent medications, see Table 8 and Supplementary Figure , available at http://onlinelibrary.wiley.com/doi/10.1002/acr.24180/abstract.…”

Section: Results/recommendationsmentioning

confidence: 99%

2020 American College of Rheumatology Guideline for the Management of Gout

Fitzgerald

Dalbeth

Mikuls

et al. 2020

Arthritis Care & Research

512

558

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Objective To provide guidance for the management of gout, including indications for and optimal use of urate‐lowering therapy (ULT), treatment of gout flares, and lifestyle and other medication recommendations. Methods Fifty‐seven population, intervention, comparator, and outcomes questions were developed, followed by a systematic literature review, including network meta‐analyses with ratings of the available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and patient input. A group consensus process was used to compose the final recommendations and grade their strength as strong or conditional. Results Forty‐two recommendations (including 16 strong recommendations) were generated. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first‐line ULT, including for those with moderate‐to‐severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (<40 mg/day); and a treat‐to‐target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl. When initiating ULT, concomitant antiinflammatory prophylaxis therapy for a duration of at least 3–6 months was strongly recommended. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. Conclusion Using GRADE methodology and informed by a consensus process based on evidence from the current literature and patient preferences, this guideline provides direction for clinicians and patients making decisions on the management of gout.

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Section: Results/recommendationsmentioning

confidence: 99%

2020 American College of Rheumatology Guideline for the Management of Gout

Fitzgerald

Dalbeth

Mikuls

et al. 2020

Arthritis Care & Research

512

558

View full text Add to dashboard Cite

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“…In the randomized and controlled fenofibrate intervention and event lowering in diabetes (FIELD) study conducted to determine the effect of fenofibrate on type 2 diabetes, uric acid levels were decreased by 10.3% in 622 patients with diabetes who took allopurinol. In addition, the first gout event in 5 years was more frequent with placebo treatment than with fenofibrate among patients with diabetes 31 .…”

Section: Discussionmentioning

confidence: 94%

Effect of fenofibrate on uric acid level in patients with gout

Jung

Choi

Suh

et al. 2018

Sci Rep

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Gout is a chronic disease associated with deposition of monosodium urate crystals and accompanied by diabetes, hypertension, and dyslipidemia. Hypertriglyceridemia is common among patients with gout, and fenofibrate is usually used to reduce triglyceride levels. The aim of this study is to determine the effect of uric acid reduction by fenofibrate in patients with gout administered uric acid lowering agents (viz., the xanthine oxidase inhibitors allopurinol and febuxostat). Data from 863 patients with gout were collected from electronic medical records comprising information on underlying diseases, laboratory findings, and drug histories. Among all the patients, 70 (8.11%) took fenofibrate with allopurinol or febuxostat. Male and young patients took fenofibrate more frequently, and hypertension was less frequent in patients administered xanthine oxidase inhibitors and fenofibrate than in those administered only xanthine oxidase inhibitors. After the treatment, serum uric acid levels more significantly decreased (−1.81 ± 2.41 vs. −2.40 ± 2.28 mg/dL, p = 0.043) in patients with fenofibrate cotreatment, than in those administered allopurinol or febuxostat alone. The effect of uric acid reduction was larger (b = −1.098, p < 0.001) in patients taking glucocorticoids than in those administered other treatments. There was no difference in the levels of creatinine, blood urea nitrogen, and aminotransferases between patients treated with and without fenofibrate. Fenofibrate additionally reduced uric acid levels without showing any change in the results of renal or liver function tests, suggesting that the addition of fenofibrate is a reasonable option for treating gout in patients having high triglyceride levels.

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“…We used two approaches to identify suspected gout flare following prior reports. 8 First we searched the adverse events database for records including permutations of the term 'gout' (gout, gouty arthritis, and gouty tophus). Second, we searched the concomitant medications database for recorded post-randomization prescription of a medication used for the long-term management of gout (allopurinol, benzbromarone, febuxostat, or probenecid) or the management of acute gout flare (colchicine, non-steroidal anti-inflammatory agents, or corticosteroids).…”

Section: Discussionmentioning

confidence: 99%

The effects of canagliflozin on gout in type 2 diabetes: a post-hoc analysis of the CANVAS Program

Badve

Zhou

et al. 2019

The Lancet Rheumatology

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Research in context Evidence before this study Elevated levels of serum urate are associated with gout, and precipitated urate crystals around the joints can trigger an inflammatory response leading to acute gout flare. The sodium glucose cotransporter 2 (SGLT2) inhibitor canagliflozin has been shown to reduce the risks of serious cardio-renal complications and reduce serum urate in patients with type 2 diabetes, but effects on gout flare are unknown.

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Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study

Cited by 48 publications

References 32 publications

2020 American College of Rheumatology Guideline for the Management of Gout

2020 American College of Rheumatology Guideline for the Management of Gout

Effect of fenofibrate on uric acid level in patients with gout

The effects of canagliflozin on gout in type 2 diabetes: a post-hoc analysis of the CANVAS Program

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