Intensive treatment reduces serum urate in patients with diabetes, hyperuricaemia

An intensive urate-lowering strategy with verinurad plus febuxostat helps lower serum urate levels and reduce albuminuria in patients with type 2 diabetes mellitus (T2DM) and hyperuricaemia, according to the results of a phase II trial.

Sixty adult patients (mean age, 61.5 years; 70 percent male) were randomized to receive verinurad 9 mg plus febuxostat 80 mg (n=32) or placebo (n=28) once daily for 24 weeks. At baseline, the combination group had higher urine albumin-to-creatinine ratio (UACR; mean, 459.1 vs 411.6 mg/g) and lower kidney function (mean estimated glomerular filtration rate [eGFR], 59.2 vs 68.1 mL/min/1.73 m²). Overall, 47 percent of patients had a baseline eGFR of <60 mL/min/1.73 m².

Compared with placebo, combination treatment resulted in a significant decrease in UACR at week 1 (–38.6 percent, 90 percent confidence interval [CI], –60.9 to –3.6), week 12 (–39.4 percent, 90 percent CI, –61.8 to –3.8), and week 24 (–49.3 percent, 90 percent CI, –68.2 to –19.0). At treatment conclusion, UACR was lower in the combination group despite having higher baseline levels.

Likewise, serum urate (sUA) levels in the combination group were lower by 59.6 percent at week 12 and by 63.7 percent at week 24 than in the placebo group.

There were no clinically meaningful changes seen in eGFR, serum creatinine, and serum cystatin C concentrations. Verinurad and febuxostat were well tolerated, and no treatment-related serious adverse events occurred.

However, the sample size and study duration were insufficient to assess the definitive effects of verinurad and febuxostat on UACR and kidney function. Moreover, the study population excluded patients with stage 4 and 5 chronic kidney disease, limiting the generalizability of the findings.