Cardiovascular Events During Treatment With Xanthine Oxidoreductase Inhibitors in Patients With Gout and Hyperuricemia in Japan - A JMDC Claims Database Study.

Background: Studies have shown an increased risk of cardiovascular events during treatment with febuxostat vs. allopurinol, but comparative data with another xanthine oxidoreductase inhibitor (XORi), topiroxostat, are lacking. In this retrospective study we compared the incidence of cardiovascular/renal events in Japanese patients with newly diagnosed hyperuricemia and/or gout treated with allopurinol, febuxostat or topiroxostat.

Methods And Results: Data came from the JMDC Claims Database from September 2013-September 2019. Participants (n=24,112, age ≥20 years, ≥93% male) were diagnosed with hyperuricemia and/or gout and prescribed XORi treatment in the same month or the following month. Using a Poisson regression model, the adjusted risk (rate ratio [RR]; 95% confidence interval [CI]) of major adverse cardiovascular events was slightly lower with topiroxostat vs. allopurinol (0.63; 0.28-1.41) and febuxostat (0.64; 0.31-1.30). Adjusted risks (RR [95% CI]) for events during treatment with topiroxostat vs. febuxostat and allopurinol were 0.22 [0.10-0.48] and 0.26 [0.11-0.63], respectively, for heart failure, 0.43 [0.27-0.67] and 0.51 [0.31-0.86], respectively, for total cardiovascular events, and 0.46 [0.30-0.69] and 0.62 [0.39-0.98], respectively, for total cardiovascular + renal events. Adjusted risks of atrial fibrillation, heart failure, dialysis, total cardiovascular events, and total cardiovascular + renal events were significantly higher with febuxostat vs. allopurinol.

Conclusions: Topiroxostat may provide a better tolerated option for the treatment of hyperuricemia and/or gout in Japanese patients with respect to cardiovascular events.