Effectiviteit en verdraagbaarheid van urinezuurverlagende behandeling: Gerandomiseerd gecontroleerd onderzoek van benzbromaron versus probenecide bij jicht na falen van allopurinol

Objective: In this study we investigated 1. the efficacy and tolerability of allopurinol (first-choice urate-lowering treatment); 2. the efficacy and tolerability of benzbromarone versus probenecid. Design and methods: Randomised controlled, open-label, multi-centre trial of patients recently diagnosed with gout. Patients were given allopurinol 300 mg for two months (stage 1). When allopurinol was not tolerated or failed to attain the target serum urate concentration (sUr) of ≤0.30 mmol/L, patients were randomised to benzbromarone 200 mg/day or probenecid 2000 mg/day and treated for two months (stage 2). Results: 96 patients were enrolled in stage 1. 82 patients (85%) were eligible for analysis: using allopurinol, sUr decreased 36% (±11%) from baseline value; 20 patients (24%; 95%CI 16-35) attained target sUr; 9 patients (11%) stopped allopurinol because of adverse drug reactions. 62 patients were enrolled in stage 2: 27 patients received benzbromarone and 35 received probenecid. With benzbromarone 22 out of 24 eligible patients were treated successfully (92%; 95%CI 73-99). Treatment success with probenecid was 20 out of 31 eligible patients (65%; 95%CI 45-81), which was significantly less than with benzbromarone (p = 0.03). Compared with baseline values, sUr decreased 64% (±9%) using benzbromarone and 50% (±7%) using probenecid, which was significantlyless than with benzbromarone (p <0.001). Conclusion: In stage 1, we found a poor efficacy and tolerability profile of allopurinol 300 mg/day after two months of treatment. In stage 2, benzbromarone 200 mg/day was more effective and better tolerated than probenecid 2000 mg/day.