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Correspondence
Fenofibrate: a new treatment for hyperuricaemia and gout?
  1. A L HEPBURN
  1. S A KAYE
  1. M D FEHER
  1. Rheumatology Section
  2. Imperial College School of Medicine
  3. Hammersmith Hospital
  4. Du Cane Road
  5. London W12 0NN, UK
  6. Rheumatology Department
  7. Chelsea and Westminster Hospital
  8. Fulham Road
  9. London SW10 9NH, UK
  10. Lipid Clinic
  11. Chelsea and Westminster Hospital
  1. Dr Hepburn

https://doi.org/10.1136/ard.60.10.984a

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    Allopurinol is the most commonly used drug in the prevention of gout owing to its efficacy and good tolerability. However, some patients still experience hyperuricaemia or gout, or both, despite allopurinol treatment. Fenofibrate is an established treatment for many common lipid disorders and is unique amongst the fibric acid derivatives because of its ability to lower serum urate by increasing renal uric acid clearance.1 This urate lowering property has been demonstrated in healthy volunteers1 and in diabetic and non-diabetic patients with hyperlipidaemia.2-4

    To date, no studies have specifically evaluated the urate lowering effect of fenofibrate in patients with hyperuricaemia receiving established treatment with allopurinol. We report three cases in which micronised fenofibrate, a single dose formulation of the drug, was initiated in patients with established gout and hyperuricaemia, with and without coexisting hyperlipidaemia. Two of these patients were already receiving established allopurinol treatment.

    PATIENT 1

    A 74 year old Chinese man had recurrent attacks of gout affecting the metatarsophalangeal joints every two to three months for the preceding three years. He had treated hypertension and polygenic hypercholesterolaemia and had been taking allopurinol 300 mg daily for three months, which produced a serum urate range between 0.40 and 0.44 mmol/l. The 24 hour renal uric acid clearance was 6.4 ml/min (reference range 6–11). Treatment was started with micronised fenofibrate 200 mg daily, and three weeks later his urate had fallen by 35% to 0.26 mmol/l, with the 24 hour uric acid clearance rising to 11.5 ml/min (table 1). Alkaline phosphatase …

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