Febuxostat vs benzbromarone: Which is more effective in CKD with hyperuricaemia, hypertension?

Treatment with either febuxostat or benzbromarone results in comparable outcomes among patients with stage G3 chronic kidney disease (CKD) with asymptomatic hyperuricaemia and hypertension, a study has shown.

Ninety-five patients with stage G3 CKD were included in this open-label randomized parallel-group clinical trial. They also presented with hypertension and hyperuricaemia without a history of gout. The investigators randomized participants to receive either febuxostat (n=47) or benzbromarone (n=48). Treatment was titrated to reduce the patients’ serum urate level to <6.0 mg/dl.

Change in estimated glomerular filtration rate (eGFR) from baseline to 52 weeks was the primary endpoint. Secondary endpoints included changes in uric acid level, blood pressure, urinary albumin-to-creatinine ratio, and xanthine oxidase (XO) activity.

Eighty-eight patients (92.6 percent) completed the trial. No significant differences were observed in change in eGFR between the febuxostat (‒0.23, 95 percent confidence interval [CI], ‒2.00 to 1.55) and benzbromarone (‒2.18, 95 percent CI, ‒3.84 to ‒0.52) groups (difference, 1.95, 95 percent CI, ‒0.48 to 4.38; p=0.115).

Secondary endpoints, except for XO activity, were also comparable between groups. Moreover, febuxostat treatment resulted in significant reductions in XO activity (p=0.010).

In subgroup analysis, the febuxostat group showed a significantly less decrease in eGFR compared with that of the benzbromarone group in CKDG3a, but not in CKDG3b. No treatment-related adverse effects were noted with either drug.

“No significant differences were found in the effects of febuxostat and benzbromarone in renal function decline in stage G3 CKD complicated with hyperuricaemia and hypertension,” the investigators said.