Loading ...

TOPLINE:

Obesity significantly reduced the effectiveness of febuxostat-based urate-lowering therapy among men with gout, with those with obesity showing lower target achievement rates and more flares than their normal-weight counterparts.

METHODOLOGY:

• This prospective cohort study evaluated the response to febuxostat in men with gout, who were classified into different body mass index (BMI) categories: Normal weight (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 28), and obese (BMI ≥ 28).
• Overall, 527 men (age, 18-70 years) who received 20 mg febuxostat daily for the first 4 weeks, with the dose increased to 40 mg daily if serum urate (SU) levels remained > 6 mg/dL during follow-up visits every 4 weeks, completed the study.
• The primary outcome was the achievement rate of SU levels < 6 mg/dL after 12 weeks of treatment.
• The secondary outcomes included the achievement rate of SU levels < 5 mg/dL and the proportion of patients requiring 40 mg febuxostat daily after 12 weeks.

TAKEAWAY:

• A significantly lower proportion of men in the obese group (38.9%) reached an SU level of < 6 mg/dL than those in the overweight (54.2%) and normal-weight (63.8%) groups at week 12 (P < .05).
• Likewise, only 10.6% of men in the obese group vs 25.7% of those in the normal-weight group achieved SU levels < 5 mg/dL at week 12 (P < .05).
• Men in the obese and overweight groups had a higher cumulative incidence of gout flares than those in the normal weight group (P < .05).
• Older age increased the likelihood of achieving the febuxostat-based urate-lowering therapy target, whereas a high BMI and a positive family history of gout decreased its likelihood.

IN PRACTICE:

"Personalized medication is necessary for obese male patients to prevent gout flares and achieve SU targets in the management of gout," the authors wrote.

SOURCE:

This study was led by Zan Cheng, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, Qingdao, China, and Xinmiao Xu, Yantai Yeda Hospital, Yantai, China. It was published online on February 10, 2025, in Rheumatology.

LIMITATIONS:

This study was limited by its single-center design and focus on only men, which may have affected the generalizability of the results. Dietary and lifestyle factors were not comprehensively documented despite patients receiving dietary education. Patients were grouped solely on the basis of BMI without considering other measurements such as waist circumference or waist-to-hip ratio.

DISCLOSURES:

This study was supported by grants from the National Natural Science Foundation of China, Taishan Scholar Programme of Shandong Province, and other sources. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.