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Impact of diuretics on the urate lowering therapy in patients with gout: analysis
of an inception cohort
#MMPMID29566736
Ranieri L
; Contero C
; Peral ML
; Calabuig I
; Zapater P
; Andres M
Arthritis Res Ther
2018[Mar]; 20
(1
): 53
PMID29566736
show ga
BACKGROUND: Diuretics have been associated with impaired response and
refractoriness in gout, but whether this effect is still present with new
urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of
the present study was to assess the impact of the diuretics on the response to
ULD in patients with gout. METHODS: This was a retrospective analysis of an
inception cohort. Participants were classified according to the type of ULD
prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum
urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5
mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics
(loop and/or thiazide). We adjusted for confounders using multiple linear
regression analysis. RESULTS: We included 245 patients: 208 treated with
allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics,
57.6%), and 2 with benzbromarone. Significantly fewer participants in the
allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but
we found no other significant differences in SU targets associated with
diuretics. Regarding the maximum ULD dose, a simple linear regression suggested
an inverse relationship with diuretics (beta = -?0.125, p = 0.073), but this did
not hold in the multivariable analysis (beta = -?0.47, p = 0.833). There was no
association with febuxostat (beta = -?0.116, p = 0.514). CONCLUSION: Diuretics do
not appear to have a significant impact on managing gout.
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