Febuxostat effectively lowers serum urate levels and prevents further renal decline in patients with advanced chronic kidney disease (CKD), according to findings published in Seminars in Arthritis and Rheumatology.

Researchers conducted a systematic review and meta-analysis of PubMed, EMBASE, Ovid MEDLINE, and the Cochrane Library databases to assess febuxostat’s ability to lower serum urate levels and affect renal function in patients with advanced CKD. Out of 2180 identified studies, the researchers only fully reviewed 148 studies and included 5 relevant observational studies with 327 patients in their meta-analysis. These patients had not started dialysis and had confirmed hyperuricemia.

Among the 5 studies, febuxostat dosing and duration of daily administration ranged from 10 to 120 mg and 3 to 12 months, respectively.

All 5 studies assessed changes in urate levels in response to febuxostat. Febuxostat effectively decreased serum urate levels (weighted mean difference, -1.85 mg/dL; 95% CI, -2.04 to -1.67 mg/dL; I2, 0%).

Only 3 of the 5 studies evaluated renal function using estimated glomerular filtration rate. The researchers did not observe any declines in renal function after febuxostat administration (weighted mean difference, 0.07 mL/min/1.73m2; 95% CI, -0.25 to 0.47 mL/min/1.73m2; I2, 45%), indicating the safe use of this medication among patients with advanced CKD.

Limitations of the study include the small number of included studies, heterogeneity of febuxostat dosages, relatively short-term follow-up periods, and the use of observational studies.

The study authors conclude, “Overall, our meta-analysis indicated that febuxostat has urate-lowering efficacy and no renal safety signal in patients with hyperuricemia and stage 4-5 CKD, who are not yet on dialysis. These results provide some reassurance about the use of febuxostat in patients with advanced CKD in clinical practice.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Jeong HJ, Park WY, Kim SH, Dalbeth N, Son CN. Urate-lowering efficacy and renal safety of febuxostat in patients with hyperuricemia and stage 4-5 chronic kidney disease not yet on dialysis: A meta-analysis of observational studies.Semin Arthritis Rheum. 2022;56:152073. doi:10.1016/j.semarthrit.2022.152073