Benzbromarone in the treatment of gout

Abstract Background Benzbromarone is a uricosuric drug that has been used in the treatment of gout over the last 30 years. Due to its potent inhibition of the dominant apical (luminal) urate exchanger in the human proximal tubule URAT1, it reduces the urate reabsorption, diminishing serum urate levels and therefore preventing gout flares. Main body of the abstract Through several clinical trials, Benzbromarone has been proved effective and safe, inclusive in patients with chronic kidney disease and as combination therapy with allopurinol. Due to hepatotoxicity reports, it was withdrawn from the European market by the manufacturer, however many authors have questioned the product's withdrawal due to a lack of clinical evidence in order to support its hepatotoxicity. Benzbromarone is still available in several European countries, New Zealand, Brazil and several other countries. Despite the product's marketing over more than 20 years after the first hepatotoxicity reports, we have found only five reports in our literature search, and no prospective or retrospective study correlating hepatotoxicity with benzbromarone use. Short conclusion Benzbromarone is a safe and effective molecule for the treatment of gout. However, due to in vitro and in vivo data related to hepatotoxicity, it is prudent to prescribe it with some caution, especially for patients with an already known liver condition.

Prevention of Comorbidity and Acute Attack of Gout by Uric Acid Lowering Therapy

The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA) or =6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at baseline and at last follow-up visit. Frequency of acute gout attacks were also compared between the groups. During the mean follow up period of 7.6 yr, the yearly rate of acute attack and the new development of HTN, DM, CVD and urolithiasis was lower in the adequately treated group compared to the inadequately treated group. Tight control of uric acid decreases the incidence of acute gout attacks and comorbidities of gout such as HTN, DM, CVD and urolithiasis.

Avaliaçäo da funçäo renal de pacientes portadores de gota em uso da benzobromarona / Evaluation of renal function in patients with gout using with benzbromarone

A funçäo renal de 20 pacientes portadores de gota primária foi avaliada em estudo aberto, näo comparativo e unicêntrico, na vigência de tratamento com benzobromarona*. Foram incluídos no presente estudo somente pacientes normo ou hipoexcretores de ácido úrico. O fármaco foi administrado por via oral, na posologia de 100 mg diários, em uma única tomada, durante três semanas. Constatou-se um flagrante aumento da uricosúria em todos os casos avaliados, bem como uma acentuada reduçäo da uricemia. Os valores de calcemia, calciúria, fosfatemia, uréia, creatinina, sódio, potássio e a clearance de creatinina urinária näo mostraram alteraçöes importantes. Quanto à tolerabilidade ao medicamento, esta foi considerada boa, apesar de efeitos colaterais, facilmente controláveis, estarem presentes em 10 (50%) pacientes. Em nenhum dos casos foi necessário interromper-se a terapia