Efficacy of Benzbromarone in Hyperuricemic Patients Associated with Chronic Kidney Disease

Fujimori, Shin; Ooyama, Keiko; Oda, Hiroshi; Moromizato, Hitoshi

doi:10.1080/15257770.2011.622732

Cited by 27 publications

(24 citation statements)

References 1 publication

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“…Finally, benzbromarone is not recommended for use in patients with eGFR <30 mL/min, but can be used in patients with moderate renal impairment171 172 because it is predominately metabolised by the liver.

In patients with crystal-proven severe debilitating chronic tophaceous gout and poor quality of life, in whom the SUA target cannot be reached with any other available drug at the maximal dosage (including combinations), pegloticase is indicated.

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Section: Resultsmentioning

confidence: 99%

2016 updated EULAR evidence-based recommendations for the management of gout

et al. 2016

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BACKGROUND:\ud New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations.\ud METHODS:\ud \ud The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach.\ud RESULTS:\ud \ud Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended.\ud CONCLUSIONS:\ud These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease

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Section: Resultsmentioning

confidence: 99%

2016 updated EULAR evidence-based recommendations for the management of gout

et al. 2016

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“…They concluded that although the renal function impairment did not improve by reducing the SUA levels with benzbromarone, the renal function did not deteriorate further on the therapy. These results suggest that benzbromarone is applicable to the management of hyperuricemia associated with renal impairment [84]. To better evaluate efficacy and safety of benzbromarone treatment in CKD patients with asymptomatic hyperuricemia, we are conducting an RCT (URATE study UMIN #000001575).…”

Section: Benzbromaronementioning

confidence: 93%

“…Benzbromarone is reported to be safe and the drug of choice in the refractory hyperuricemia [82] and alleged hepatotoxicity is now refuted to take place [83]. Although a retrospective and small-sized study, one report is found that 35 hyperuricemic CKD patients with renal impairment of stage 3 or higher (stage 3 in 32 patients, stage 4 in 2 patients, and stage 5 in 1 patient) showed significant decrease in SUA from 8.5 ± 0.9 to 6.1 ± 0.8 mg/dL at 6 months [84]. Most patients received benzbromarone at a dose of 25-50 mg/day, whereas 150-200 mg/day was used in some patients with stage 4 or 5 CKD.…”

Section: Benzbromaronementioning

confidence: 97%

Time to target uric acid to retard CKD progression

et al. 2016

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Uric acid (UA) remains a possible risk factor of chronic kidney disease (CKD) but its potential role should be elucidated given a fact that multidisciplinary treatments assure a sole strategy to inhibit the progression to end-stage renal disease (ESRD). In clinical setting, most observational studies showed that elevation of serum uric acid (SUA) independently predicts the incidence and the development of CKD. The meta-analysis showed that SUA-lowering therapy with allopurinol may retard the progression of CKD but did not reach conclusive results due to small-sized studies. Larger scale, randomized placebo-controlled trials to assess SUA-lowering therapy are needed. Our recent analysis by propensity score methods has shown that the threshold of SUA should be less than 6.5 mg/dL to abrogate ESRD. In animal models an increase in SUA by the administration of oxonic acid, uricase inhibitor, or nephrectomy can induce glomerular hypertension, arteriolosclerosis including afferent arteriolopathy and tubulointerstitial fibrosis. The ever-growing discoveries of urate transporters prompt us to learn UA metabolism in the kidney and intestine. One example is that the intestinal ABCG2 may play a compensatory role at face of decreased renal clearance of UA in nephrectomized rats, the trigger of which is not a uremic toxin but SUA itself. This review will summarize the recent knowledge on the relationship between SUA and the kidney and try to draw a conclusion when and how to treat asymptomatic hyperuricemia accompanied by CKD. Finally we will address a future perspective on UA study including a Mendelian randomization approach.

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“…In fact, a retrospective study reported that patients with renal impairment (CKD stage 3 or higher) receiving benzbromarone monotherapy did not observe a further deterioration in renal function. 20) As described above, benzbromarone directly scavenges ROS, such as O 2 ·− and LOO · , at clinical concentrations (Figs. 1, 2).…”

Section: Discussionmentioning

confidence: 99%

Direct Radical Scavenging Activity of Benzbromarone Provides Beneficial Antioxidant Properties for Hyperuricemia Treatment

Kadowaki

Sakaguchi

Miyamoto

et al. 2015

Biological & Pharmaceutical Bulletin

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Uric acid exerts an important antioxidant effect against external oxidative stress under physiological conditions. However, uric acid itself can increase oxidative stress via reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation in adipocytes and vascular cells. Uric acid transporter 1 is involved in the generation of this oxidative stress. Furthermore, uric acid locally activates the renin-angiotensin system, thus producing angiotensin II and subsequently increasing intracellular oxidative stress. Benzbromarone has been reported to suppress uric acid reabsorption via uric acid transporter 1 inhibition in renal tubular cells. In this study we evaluated the in vitro antioxidant effect of benzbromarone from several perspectives. First, the direct radical-trapping capacity of benzbromarone was measured by chemiluminescence assay and electron paramagnetic resonance spectroscopy. Second, the intracellular antioxidant activity of benzbromarone in hyperuricemia was evaluated using endothelial cells. In light of these results, benzbromarone is hypothesized directly to scavenge the superoxide anion radical. In addition, benzbromarone inhibited reactive oxygen species production that was induced by angiotensin II or uric acid in endothelial cells. These findings suggest that benzbromarone possesses the ability directly to scavenge radicals and may act as an antioxidant against uric acid and angiotensin II-induced oxidative stresses in endothelial cells at therapeutically achievable levels in blood.

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Efficacy of Benzbromarone in Hyperuricemic Patients Associated with Chronic Kidney Disease

Cited by 27 publications

References 1 publication

2016 updated EULAR evidence-based recommendations for the management of gout

2016 updated EULAR evidence-based recommendations for the management of gout

Time to target uric acid to retard CKD progression

Direct Radical Scavenging Activity of Benzbromarone Provides Beneficial Antioxidant Properties for Hyperuricemia Treatment

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