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Lee JS, Won J, Kwon OC, Lee SS, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Hepatic Safety of Febuxostat Compared with Allopurinol in Gout Patients with Fatty Liver Disease. J Rheumatol 2018; 46:527-531. [PMID: 30442825 DOI: 10.3899/jrheum.180761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Febuxostat has superior renal safety to allopurinol, but data on its hepatic safety are limited. Thus we compared the hepatotoxicity of febuxostat and allopurinol, and the clinical factors associated with hepatotoxicity, in patients with gout and fatty liver disease (FLD). METHODS We included gout patients treated with allopurinol or febuxostat who were diagnosed with fatty liver based on ultrasonography or computed tomography. Hepatotoxicity was defined as follows: (1) elevation of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) at least 3× the upper limit of normal, when the baseline AST/ALT was normal; or (2) doubling of the baseline AST/ALT, when the baseline AST/ALT was elevated. The factors associated with hepatotoxicity were evaluated by Cox regression analysis. RESULTS Of 134 patients identified with gout and FLD, 32 (23.9%) received febuxostat and 102 (76.1%) received allopurinol. There were no significant differences in age, body mass index, comorbidity, or disease severity between the groups; however, the incidence of hepatotoxicity was significantly lower in the febuxostat group (3/32, 9.4%) than in the allopurinol group (36/102, 35.3%, p = 0.005). Diabetes (HR 3.549, 95% CI 1.374-9.165, p = 0.009) and colchicine use (HR 11.518, 95% CI 5.515-24.054, p < 0.001) were associated with a higher risk of hepatotoxicity, whereas febuxostat use was associated with a lower risk of hepatotoxicity (HR 0.282, 95% CI 0.086-0.926, p = 0.037). CONCLUSION In the 32 patients studied, febuxostat was well tolerated in patients with gout and FLD. However, the presence of diabetes and colchicine use may increase the risk of hepatotoxicity.
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Affiliation(s)
- Jung Sun Lee
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Jebum Won
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Oh Chan Kwon
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Seung Soo Lee
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Ji Seon Oh
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Yong-Gil Kim
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Chang-Keun Lee
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Bin Yoo
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center
| | - Seokchan Hong
- From the Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center; Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. .,J.S. Lee, MD, Department of Rheumatology, Asan Medical Center; J. Won, MD, Department of Rheumatology, Asan Medical Center; O.C. Kwon, MD, Department of Rheumatology, Asan Medical Center; S.S. Lee, MD, PhD, Department of Radiology, Asan Medical Center; J.S. Oh, MD, PhD, Clinical Research Center, University of Ulsan College of Medicine, Asan Medical Center; Y.G. Kim, MD, PhD, Department of Rheumatology, Asan Medical Center; C.K. Lee, MD, PhD, Department of Rheumatology, Asan Medical Center; B. Yoo, MD, PhD, Department of Rheumatology, Asan Medical Center; S. Hong, MD, PhD, Department of Rheumatology, Asan Medical Center.
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