Treatment of
gout and
hyperuricemia can be difficult in patients with
chronic renal failure. At present, there is no study available comparing the efficacy of the most widely used agent,
allopurinol, and the uricosuric
benzbromarone for the control of
hyperuricemia in patients with
renal insufficiency. We describe an open, randomized, actively controlled, comparative trial in patients with clearance of
creatinine from 20 to 80 mL/ min/1.73 m(2). Patients were randomized to take
benzbromarone (100-200 mg/day) or
allopurinol (100-300 mg/day). Outcome variables were the following: reduction of serum
urate (Sur), Sur & tl; 6 mg/dL (357 micromol/L), reduction of gouty bouts and reduction of tophi. During 9-24 months of follow-up 36 patients were studied.The reduction of Sur was higher with
benzbromarone, and only 1 of 17 patients taking
benzbromarone did not achieve Sur < 6 mg/dL versus 7 of 19 taking
allopurinol. Patients who did not reach optimal Sur levels with
allopurinol were more frequently taking
diuretics and showed lower fractional excretion of
urate and higher initial Sur levels than patients with proper control of Sur. Seven patients with suboptimal control of serum
urate were changed to
benzbromarone 100 mg/day, which showed efficacy similar in those who were initially randomized to
benzbromarone. A reduction of gouty bouts and size of tophi was observed after proper control of Sur.
Allopurinol is effective in controlling
hyperuricemia, but patients with higher initial Sur levels or taking concomitant
diuretic therapy are less prone to reach therapeutic goals.Benzbromarone is useful for the control of
hyperuricemia in patients with
renal insufficiency even with concomitant
diuretic administration; patients benefited include those who previously had no improvement by taking
allopurinol.