Liver Safety of Febuxostat Compared with Allopurinol in Gout Patients with Fatty Liver Disease

Jung Sun Lee¹, Seokchan Hong², Jebum Won¹, Oh Chan Kwon², Ji Seon Oh², Yong-Gil Kim², Chang Keun Lee² and Bin Yoo², ¹Division of Rheumatology, Department of Internal Medicine,, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of (South), ²Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of (South)

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Fatty liver, febuxostat and gout

Session Information

Date: Tuesday, October 23, 2018

Session Title: Metabolic and Crystal Arthropathies – Basic and Clinical Science Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Although febuxostat has been widely used for lowering uric acid levels because of its renal safety compared with allopurinol, data on the hepatic safety of febuxostat is limited. Therefore, the purpose of this study was to investigate the hepatotoxicity of febuxostat compared with allopurinol in gout patients with fatty liver disease and the clinical factors associated with hepatotoxicity.

Methods: This study involved gout patients exposed to allopurinol or febuxostat and diagnosed with fatty liver based on liver ultrasonography or CT. Hepatotoxicity was defined as follows: (1) elevation of aspartate transaminase (AST)/alanine transaminase (ALT) at least 3 times the upper normal limit for subjects with normal AST/ALT at baseline and (2) doubling of the baseline AST/ALT for subjects with elevated AST/ALT at baseline. The factors associated with hepatotoxicity were evaluated by Cox regression analysis.

Results: Of 134 gout patients with fatty liver disease, 32 patients (23.9%) received febuxostat, and 102 patients (76.1%) received allopurinol. There was no significant difference in the age, BMI, comorbidity, or fatty liver disease severity between patients taking febuxostat and those taking allopurinol. However, the incidence of hepatotoxicity was significantly lower in the febuxostat group than in the allopurinol group (3/32 (9.4%) vs. 36/102 (35.3%), p = 0.005). In multivariate analysis, diabetes (HR: 3.549, 95% CI: 1.374–9.165, p = 0.009) and the use of colchicine (HR: 9.122, 95% CI: 4.601–18.084, p < 0.001) were associated with hepatotoxicity. In contrast, the use of febuxostat was associated with a lower risk of hepatotoxicity (HR: 0.282, 95% CI: 0.086–0.926, p = 0.037).

Conclusion:: Febuxostat was well tolerated in gout patients with fatty liver disease in terms of hepatotoxicity. Diabetes and the use of colchicine seem to be important factors related to the risk of hepatotoxicity.

Disclosure: J. S. Lee, None; S. Hong, None; J. Won, None; O. C. Kwon, None; J. S. Oh, None; Y. G. Kim, None; C. K. Lee, None; B. Yoo, None.

To cite this abstract in AMA style:

Lee JS, Hong S, Won J, Kwon OC, Oh JS, Kim YG, Lee CK, Yoo B. Liver Safety of Febuxostat Compared with Allopurinol in Gout Patients with Fatty Liver Disease [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/liver-safety-of-febuxostat-compared-with-allopurinol-in-gout-patients-with-fatty-liver-disease/. Accessed February 3, 2023.

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