Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout

Objective. To assess the short-term urate-lowering effect of fenofibrate in men on long-term allopurinol therapy for hyperuricaemia and gout. Methods. Ten male patients (38-74 yr) with a history of chronic tophaceous or recurrent acute gout with hyperuricaemia and on established allopurinol at 300-900 mg/day for ≥ 3 months were studied in an open-crossover study of fenofibrate therapy. Allopurinol at the established dose was continued throughout the study. Clinical and biochemical assessments (serum urate and creatinine, 24-h urinary excretion of urate and creatinine, liver function tests, creatine kinase and fasting serum lipids) were undertaken at: (i) baseline, (ii) after 3 weeks of once-daily therapy with micronized fenofibrate (Lipantil Micro R ) at 200 mg and (iii) 3 weeks after fenofibrate was withdrawn. Results. Fenofibrate was associated with a 19% reduction in serum urate after 3 weeks of treatment (mean±S.E. 0.37±0.04 vs 0.30±0.02 mM/l; P=0.004). The effect was reversed after a 3-week fenofibrate withdrawal period (0.30±0.02 vs 0.38±0.03 mM/l). There was a rise in uric acid clearance with fenofibrate treatment of 36% (7.2±0.9 vs 11.4±1.6 ml/min, normal range 6-11; P=0.006) without a significant change in creatinine clearance. Both total cholesterol and serum triglycerides were also reduced. No patient developed acute gout whilst taking fenofibrate. Conclusions. Fenofibrate has a rapid and reversible urate-lowering effect in patients with hyperuricaemia and gout on established allopurinol prophylaxis. Fenofibrate may be a potential new treatment for hyperuricaemia and the prevention of gout, particularly in patients with coexisting hyperlipidaemia or those resistant to conventional therapy for hyperuricaemia.