The study, of a nationally representative sample of Medicare patients, showed that allopurinol was associated with a greater reduction in the risk of incident kidney disease, report the authors online July 13 in Annals of the Rheumatic Diseases.
“The association of allopurinol with renal protection was dose-related, and possibly duration-related, with higher reduction of hazard of incident renal disease with higher allopurinol doses,” report Dr. Jasvinder Singh and Dr. John Cleveland from the University of Alabama at Birmingham.
For the study, the researchers analyzed Medicare claims data on more than 31,000 new allopurinol or febuxostat treatment episodes (with no renal failure at baseline) in some 26,000 patients, of which 8,570 ended in incident renal disease.
Crude rates of incident renal disease per 1,000 person-years were lower with allopurinol than febuxostat (192 vs. 338).
Crude rates of incident renal disease per 1,000 person-years were also lower with higher daily doses of allopurinol: 238 cases with <200 mg/d, 176 with 200-299 mg/d and 155 with >= 300 mg/d. With febuxostat 40 and 80 mg/d, rates of incident renal disease per 1,000 person-years were 341 and 326, respectively.
In propensity-matched analyses, compared with febuxostat, allopurinol use was independently associated with significantly lower hazard (39%) of incident renal disease, they report.
“Sensitivity analyses using multivariable-adjusted regression confirmed these findings,” the authors note.
“These findings indicate that allopurinol may be superior to febuxostat for renal function preservation in elderly Americans without significant baseline renal disease,” Drs. Singh and Cleveland conclude in their article.
Nonetheless, they say a randomized trial is needed to confirm these findings.
“Future studies should also assess whether renal protection with allopurinol differs by the underlying etiology of renal disease, that is, hypertension versus diabetes versus heart failure versus others. Translational studies are also needed to uncover the underlying mechanisms of this potential renal function benefit associated with allopurinol use,” Drs. Singh and Cleveland conclude.
Dr. Singh did not respond to a request for comment by press time.
The study had no commercial funding. Dr. Singh has disclosed relationships with Takeda, Savient, Regeneron and other companies.
- Singh JA., Cleveland JD. Comparative effectiveness of allopurinol versus febuxostat for preventing incident renal diseasein older adults: an analysis of Medicare claims data. Annals of Rheumatic Diseases. 2017 Jun 5.[Epub ahead of print]