Clinical rheumatology · 2025
Risk of ischemic stroke in benzbromarone versus allopurinol users: a real-world cohort study using TriNetX.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Lai Shih-Wei, Liao Kuan-Fu
Аннотация
OBJECTIVE: To investigate whether benzbromarone or allopurinol use is associated with the risk of ischemic stroke among individuals aged 20-84 years with hyperuricemia or gout.
METHODS: We conducted a retrospective cohort study utilizing 2006 to 2024 records from the TriNetX network. Individuals aged 20-84 years who used benzbromarone or allopurinol were included. To form the benzbromarone and allopurinol groups, individuals were matched 1:1 based on demographic and clinical comorbidities. The unadjusted risk ratio was estimated using the Compare Outcomes module in TriNetX. Additionally, a Cox proportional hazards regression model was applied to the unmatched cohort to estimate the adjusted hazard ratio, controlling for demographic and clinical comorbidities.
RESULTS: After matching, each group included 26,510 individuals. Over a maximum 15-year follow-up period, the cumulative incidence of ischemic stroke was 1.375% in the benzbromarone group and 1.179% in the allopurinol group. The unadjusted risk ratio was 1.166 (95% CI: 1.003-1.355). The adjusted hazard ratio from the Cox model was 1.296 (95% CI: 1.129-1.488; P = 0.0002), indicating a statistically significant increased risk of ischemic stroke associated with benzbromarone use compared to allopurinol.
CONCLUSION: Benzbromarone use was associated with a higher long-term risk of ischemic stroke compared to allopurinol among individuals aged 20-84 years with hyperuricemia or gout. Key Points What is known: • Benzbromarone and allopurinol are two commonly prescribed urate-lowering therapies for hyperuricemia and gout. • The association between these medications and the risk of ischemic stroke remains uncertain. What is new here: • In this study, benzbromarone use was associated with a significantly higher risk of ischemic stroke compared to allopurinol use. • The adjusted hazard ratio for ischemic stroke was 1.296 (95% CI: 1.129-1.488, P = 0.0002) for benzbromarone versus allopurinol. Translational impact: • These findings suggest that benzbromarone may carry a higher long-term ischemic stroke risk than allopurinol, which could inform clinical decision-making in urate-lowering therapy selection.
METHODS: We conducted a retrospective cohort study utilizing 2006 to 2024 records from the TriNetX network. Individuals aged 20-84 years who used benzbromarone or allopurinol were included. To form the benzbromarone and allopurinol groups, individuals were matched 1:1 based on demographic and clinical comorbidities. The unadjusted risk ratio was estimated using the Compare Outcomes module in TriNetX. Additionally, a Cox proportional hazards regression model was applied to the unmatched cohort to estimate the adjusted hazard ratio, controlling for demographic and clinical comorbidities.
RESULTS: After matching, each group included 26,510 individuals. Over a maximum 15-year follow-up period, the cumulative incidence of ischemic stroke was 1.375% in the benzbromarone group and 1.179% in the allopurinol group. The unadjusted risk ratio was 1.166 (95% CI: 1.003-1.355). The adjusted hazard ratio from the Cox model was 1.296 (95% CI: 1.129-1.488; P = 0.0002), indicating a statistically significant increased risk of ischemic stroke associated with benzbromarone use compared to allopurinol.
CONCLUSION: Benzbromarone use was associated with a higher long-term risk of ischemic stroke compared to allopurinol among individuals aged 20-84 years with hyperuricemia or gout. Key Points What is known: • Benzbromarone and allopurinol are two commonly prescribed urate-lowering therapies for hyperuricemia and gout. • The association between these medications and the risk of ischemic stroke remains uncertain. What is new here: • In this study, benzbromarone use was associated with a significantly higher risk of ischemic stroke compared to allopurinol use. • The adjusted hazard ratio for ischemic stroke was 1.296 (95% CI: 1.129-1.488, P = 0.0002) for benzbromarone versus allopurinol. Translational impact: • These findings suggest that benzbromarone may carry a higher long-term ischemic stroke risk than allopurinol, which could inform clinical decision-making in urate-lowering therapy selection.