478 Uricosuric medications effective for chronic gout

February 03, 2016

written by Brian R McAvoy

Clinical question
How effective are uricosuric medications for chronic gout?

Bottom line
There was no important difference between benzbromarone and allopurinol at achieving serum urate normalisation, but benzbromarone was probably more successful than probenecid at achieving serum urate normalisation in people with gout. There was some uncertainty around the effect estimates (based on low-quality evidence from only 1 or 2 trials) on the number of acute gout attacks, the number of withdrawals due to adverse events and the total number of participants experiencing adverse events when comparing benzbromarone with allopurinol. However, when compared with probenecid, benzbromarone resulted in fewer withdrawals due to adverse events, and fewer participants experiencing adverse events.

The studies did not measure pain reduction, function or tophus regression. No studies compared uricosurics with placebo. Most participants (>80%) were male, aged between 50 and 70 years and did not have significant kidney or liver disease. Trials lasted from 2 to 24 months.

Uricosuric agents have long been used in the treatment of gout, but there is little evidence regarding their benefit and safety when used for this condition.

Cochrane Systematic Review
Kydd ASR et al. Uricosuric medications for chronic gout.
Cochrane Reviews, 2014, Issue 11. Art. No.: CD010457.DOI: 10.1002/14651858. CD010457.pub2. This review contains 5 studies involving 274 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.