Participants with type 2 diabetes who took fenofibrate 200 mg once a day had lower uric acid concentrations and fewer gout events over a 5-year period compared with controls receiving placebo, according to a recent study published in The Lancet Diabetes & Endocrinology.
Whole blood samples were obtained from patients with type 2 diabetes age 50 to 75 years who were participants in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial.
Plasma uric acid concentration and number of gout attacks were studied in a post-hoc analysis and results were compared between the randomly assigned fenofibrate (n=4895) and control (n=4900) groups.
In the fenofibrate treatment group, plasma uric acid concentrations were 20.2% (95% CI, 19.9-20.5, P <.0001) lower after 6 weeks (continuing to the 1-year follow-up) and remained lower in a random subset remeasurement at 1 year. The number of gout events in the fenofibrate group were half that of the control group after 5 years (hazard ratio, 0.48; 95% CI, 0.37-0.60; P <.0001). However, these results were not seen in study participants given concomitant allopurinol.
This finding is important because overproduction and inadequate renal excretion of uric acid can lead to hyperuricemia and gout.
The study investigators wrote, “Acute gout is common in patients with type 2 diabetes, and its occurrence increases with higher uric acid concentrations.” They added, “Fenofibrate lowered plasma uric acid by an average of 20% and almost halved first on-study gout events. Fenofibrate could be a useful adjunct for treating gout in individuals with diabetes.”
Waldman B, Ansquer J-C, Sullivan DR, et al. Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study [published online February 26, 2018]. Lancet Diabetes Endocrinol. doi: 10.1016/S2213 8587(18)30029-9