Probenecid vs Allopurinol for CV Risk in Gout Patients

Probenecid use is associated with a modest decrease in the risk of cardiovascular (CV) events in elderly patients with gout, according to a recent study.

For their study, the researchers assessed 38,888 gout patients aged 65 years and older who initiated probenecid or allopurinol.
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Patients were propensity score-matched 1:3 based on probenecid use vs allopurinol, and incidence rates and hazard ratios (HR) were estimated for primary outcomes (hospitalization for myocardial infarction [MI] or stroke), as well as secondary outcomes (MI, stroke, coronary revascularization, heart failure [HF], and mortality).

Ultimately, 9722 probenecid-treated patients and 29,166 allopurinol-treated patients were propensity score-matched. The researchers calculated the incidence rate of the primary outcomes as 2.36 per 100 person-years for probenecid vs 2.83 per 100 person-years for allopurinol (HR 0.80).

Findings from secondary analyses indicated that probenecid use was associated with decreased risks for MI, stroke, HF exacerbation, and mortality compared with allopurinol use. The researchers noted that these results remained significant following subgroup analyses of patients without baseline CVD or those without baseline chronic kidney disease.

“In this large cohort of 38,888 elderly gout patients, treatment with probenecid appears to be associated with a modestly decreased risk of CV events including MI, stroke, and HF exacerbation compared with allopurinol,” the researchers concluded.

—Christina Vogt

Reference:

Kim SC, Neogi T, Kang EH, et al. Cardiovascular risks of probenecid versus allopurinol in older patients with gout. J Am Coll Cardiol. 2018;71(9). doi:10.1016/j.jacc.2017.12.052.