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Rheumatology 2003; 42: 321-325
© 2003 British Society for Rheumatology

Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout

M. D. Feher, A. L. Hepburn1, M. B. Hogarth1, S. G. Ball and S. A. Kaye1

Lipid Clinic and
1 Department of Rheumatology, Chelsea and Westminster Hospital, London SW10 9NH, UK

Objective. To assess the short-term urate-lowering effect of fenofibrate in men on long-term allopurinol therapy for hyperuricaemia and gout.

Methods. Ten male patients (38–74 yr) with a history of chronic tophaceous or recurrent acute gout with hyperuricaemia and on established allopurinol at 300–900 mg/day for >=3 months were studied in an open-crossover study of fenofibrate therapy. Allopurinol at the established dose was continued throughout the study. Clinical and biochemical assessments (serum urate and creatinine, 24-h urinary excretion of urate and creatinine, liver function tests, creatine kinase and fasting serum lipids) were undertaken at: (i) baseline, (ii) after 3 weeks of once-daily therapy with micronized fenofibrate (Lipantil Micro®) at 200 mg and (iii) 3 weeks after fenofibrate was withdrawn.

Results. Fenofibrate was associated with a 19% reduction in serum urate after 3 weeks of treatment (mean±S.E. 0.37±0.04 vs 0.30±0.02 mM/l; P=0.004). The effect was reversed after a 3-week fenofibrate withdrawal period (0.30±0.02 vs 0.38±0.03 mM/l). There was a rise in uric acid clearance with fenofibrate treatment of 36% (7.2±0.9 vs 11.4±1.6 ml/min, normal range 6–11; P=0.006) without a significant change in creatinine clearance. Both total cholesterol and serum triglycerides were also reduced. No patient developed acute gout whilst taking fenofibrate.

Conclusions. Fenofibrate has a rapid and reversible urate-lowering effect in patients with hyperuricaemia and gout on established allopurinol prophylaxis. Fenofibrate may be a potential new treatment for hyperuricaemia and the prevention of gout, particularly in patients with coexisting hyperlipidaemia or those resistant to conventional therapy for hyperuricaemia.

KEY WORDS: Fenofibrate, Allopurinol, Hyperuricaemia, Gout.

Correspondence to: M. D. Feher, Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. E-mail: m.feher{at}chelwest.nhs.uk


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