Allopurinol Versus Febuxostat Use and the Risk of Cardiovascular Disease in People With Chronic Kidney Disease: A New-User Active Comparator Cohort Study.

AIM: Hyperuricaemia, a common comorbidity among people with chronic kidney disease, is widely treated with uric acid-lowering agents such as allopurinol and febuxostat. Cardiovascular outcomes of people with chronic kidney disease receiving allopurinol or febuxostat have been controversial. The present study evaluated the risk of cardiovascular events associated with allopurinol or febuxostat treatment in people with chronic kidney disease.

METHODS

We conducted a new-user active comparator cohort study using a nationwide insurance claims database in Japan. Individuals with an estimated glomerular filtration rate < 60 mL/min/1.73 m2 who were newly prescribed allopurinol or febuxostat were included. The primary outcome was a composite of cardiovascular events, including fatal and non-fatal acute myocardial infarction, fatal and non-fatal stroke, and all-cause death. Hazard ratios were estimated using a multivariate Cox regression model. A sensitivity analysis was performed using an inverse probability of treatment weighting (IPTW) Cox regression model.

RESULTS

A total of 1673 and 7805 individuals were included in the allopurinol and febuxostat treatment groups, respectively. The febuxostat group had a similar incidence of the composite outcome as the allopurinol group (hazard ratio 0.93, 95% confidence interval: 0.79-1.08, p = 0.33). The hazard ratio for febuxostat compared with allopurinol treatment did not vary across different estimated glomerular filtration rate levels. The sensitivity analysis using IPTW showed similar results.

CONCLUSION

In conclusion, no statistically significant difference in the risk of cardiovascular events was observed in people with chronic kidney disease who were newly prescribed febuxostat compared with those newly treated with allopurinol.