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Allopurinol and benzbromarone compared

Clinical bottom line

Both drugs are effective at reducing uric acid.


The standard treatment for uric acid treatment in the UK is allopurinol. Elsewhere, particularly in Europe, benzbromarone is also used. Direct comparison between these two treatments has been found in only one trial, but that trial was not randomised. It is only described briefly here because it was the ONLY study found on a literature search.

Reference


F Perez-Ruiz et al. Efficacy of allopurinol and benzbromarone for the control of hyperuricaemia. A pathogenic approach to the treatment of primary chronic gout. Ann Rheum Dis 1998 57: 545-549.


Study

This study was neither randomised, nor blind. Patients had to have ARA criteria for gout, with no urate lowering treatment for at least one month, and be using no drugs that interfered with urate metabolism. Allocation to allopurinol or benzbromarone was on the basis of uric acid excretion and production on a diet that avoided alcohol and that was hypocaloric for overweight subjects. Allopurinol was 300 mg once daily and benzbromarone 100 mg orally once daily.

Results

There were 91 starters. Five were excluded because of poor compliance, persistent alcohol use, or loss of follow up. In all groups the mean age was about 53 years.

Serum uric acid fell in all patients. There is a suggestion that uric acid levels fell more, and that uric acid excretion was greater, with benzbromarone.

Comment

This is a detailed paper, but the lack of randomisation and open nature of the study make it almost useless for making any decisions about treating hyperuricaemia with these uric acid lowering drugs.