Febuxostat to decrease uric acid levels and aid the prevention of cerebral, cardiovascular and renal events in elderly hyperuricaemia patients, as reported by the investigators of the FREED trial (NCT01984749) during the ESC 2018 Congress.

The trial randomised 1,070 higher-risk hyperuricaemia patients aged 65 years and older 1:1 to either receive up to 36 months oral febuxostat or not.

Higher risk for cerebral, cardiovascular or renal events was defined as hypertension, type 2 diabetes mellitus, renal disorders and a history of cerebral or cardiovascular disease.

The febuxostat dose was escalated stepwise from 10 to 40 mg per day based on the tolerability. Patients randomised to the non-febuxostat group received allopurinol (100 mg) if elevated serum uric acid was present. Doses of febuxostat or allopurinol were adjusted to prevent a serum uric acid level <2 mg/dL.  All patients received lifestyle guidance regarding diet, smoking, and exercise.

“The findings suggest that lowering uric acid with febuxostat provides clinical benefit.”

~Professor Sunao Kojima, Kawasaki Medical School, Okayama, Japan

The primary composite endpoint –included cerebral, cardiovascular, and renal events, as well as death due to any cause. In the febuxostat group, primary endpoint events occurred in 23% (125/537) of patients compared to 29% (153/533) in the non-febuxostat group. Febuxostat significantly lowered primary endpoint events (HR=0.75). Table 1 shows the effect of febuxostat vs no-febuxostat on the individual components of the primary composite endpoint.

Reference

http://www.acc.org/latest-in-cardiology/articles/2018/08/22/14/15/tues-515am-freed-esc-2018