Comparing Cardiovascular Safety of Febuxostat and Allopurinol in the Real World: A Population-Based Cohort Study |
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Authors: | Ching-Yen Su Li-Jiuan Shen Song-Chou Hsieh Lian-Yu Lin Fang-Ju Lin |
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Affiliation: | 1. Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan;2. School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan;3. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan;4. Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan;5. Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan |
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Abstract: | ObjectiveTo determine and compare the risk of cardiovascular events and mortality of febuxostat and allopurinol use.Patients and MethodsWe conducted a cohort study using the Taiwan National Health Insurance Research Database. New users of febuxostat and allopurinol between April 1, 2012 and December 31, 2015 were identified, and the two groups were 1:1 matched by propensity score, benzbromarone use history, renal impairment, and time of drug initiation. The risk of major adverse cardiovascular events (MACEs), venous thromboembolism (VTE), heart failure (HF) hospitalization, atrial fibrillation hospitalization, cardiovascular (CV) death, and all-cause mortality was assessed using Cox proportional hazards models. The dose-response relationship between xanthine oxidase inhibitor use and adverse CV outcomes were also determined.ResultsA total of 44,111 patients were included for each group, and all baseline covariates were well matched. Febuxostat users were at a significantly higher risk for HF hospitalization (hazard ratio [HR], 1.22; 95% CI, 1.13-1.33), atrial fibrillation hospitalization (HR, 1.19; 95% CI, 1.05-1.36), and CV death (HR, 1.19; 95% CI, 1.03-1.36) than allopurinol users, whereas no difference was found for the major adverse cardiac events composite endpoint, venous thromboembolism, myocardial infarction, ischemic stroke, and all-cause mortality. The elevated risk of HF hospitalization was consistent throughout the primary and sensitivity analyses. In addition, febuxostat increased the risk of adverse CV outcomes in a dose-dependent manner.ConclusionThe use of febuxostat, compared with allopurinol, was associated with a significantly increased risk of adverse CV events. Higher febuxostat doses had a greater impact. Further studies are needed to investigate the mechanisms linking febuxostat to adverse CV outcomes. |
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Keywords: | AF atrial fibrillation CV cardiovascular DDD defined daily dose HF heart failure MACE major adverse cardiovascular event MI myocardial infarction PS propensity score VTE venous thromboembolism XOI xanthine oxidase inhibitor |
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