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Obesity, but not overweight, substantially impairs response to febuxostat-based urate-lowering therapy in men with gout.
A prospective cohort study led by Zan Cheng et al. has revealed that obesity markedly diminishes the likelihood of achieving target serum urate (SU) levels in male gout patients treated with febuxostat. The study, which enrolled 633 adult men diagnosed with gout, examined how different body mass index (BMI) categories—normal weight, overweight, and obese—affected response to urate-lowering therapy (ULT).
To ensure comparability, volunteers across the three BMI groups were matched for baseline age, gout duration, and initial SU levels. All individuals received febuxostat over a 12-week period, with the daily dose titrated from 20 mg to 40 mg. Researchers examined the proportion of patients reaching the target SU level of less than 6.0 mg/dl and monitored the incidence of gout flares. The proportion of volunteers achieving SU < 6.0 mg/dl in the obese group was quite lower than the overweight and normal-weight groups, with no prominent difference between the overweight and normal-weight groups at week 12 (Table 1):
The difference in SU target attainment between overweight and normal-weight volunteers, however, was not statistically significant. Further analysis using Cox regression confirmed that higher BMI was independently linked with a lower probability of reaching the SU goal. Specifically, each unit increase in BMI minimized the likelihood of SU achievement (hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.89–0.96, P < 0.001), even after adjusting for confounders through matching.
Additionally, restricted cubic spline analysis illustrated a linear inverse connection between BMI and the probability of SU target attainment, with no evidence of nonlinearity (P > 0.05). In terms of safety outcomes, both obese and overweight subjects experienced a higher cumulative incidence of gout flares during the treatment period as opposed to normal-weight individuals (P < 0.05). The findings suggest that obesity, rather than merely being overweight, negatively impacts the febuxostat's efficiency in lowering urate levels in male gout patients. These findings underscore the requisition for clinicians to consider body weight when selecting and optimizing gout care strategies.
Rheumatology
Obesity reduces the urate-lowering efficacy among patients with primary gout: a prospective cohort study
Zan Cheng et al.
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