Hypersensitivity and cardiovascular risks related to allopurinol and febuxostat therapy in Asians: A population-based cohort study and meta-analysis

Chi-Hua Chen, Chun-Bing Chen, Chee Jen Chang, Yu Jr Lin, Chuang-Wei Wang, Ching-Chi Chi, Chun-Wei Lu, Wei-Ti Chen, Ren-You Pan, Shih-Chi Su, Lung-An Hsu, Ya-Ching Chang, Kuang-Hui Yu, Yeong-Jian Jan Wu, Ko-Ming Lin, Shuen-Iu Hung, Shin-Ming Chen, Wen-Hung Chung

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Abstract

The safety of newer xanthine oxidase inhibitor-febuxostat comparing to allopurinol remains unclear. To compare the risks of allopurinol- and febuxostat-hypersensitivity and cardiovascular diseases (CVD) in Asians, we conducted a population-based cohort study enrolling patients receiving allopurinol or febuxostat from Chang Gung Memorial Hospital Health System across Taiwan during 2012-2016 and further performed a meta-analysis incorporating two recent studies. Among the 61,539 users, a corresponding 12,007 and 5,680 patients were identified as new users. The overall incidence of febuxostat-hypersensitivity was significantly lower than allopurinol-hypersensitivity (0.2v.s.2.7 per 1000 new users, P<0.001). There were 33 allopurinol-hypersensitivity (including 18 severe cutaneous adverse drug reactions) and only one patient developed febuxostat-maculopapular exanthema. Moreover, febuxostat was not statistically increased risk of CVD (HR,1.16; P=0.152) and related death (HR,1.49; P=0.496) compared to allopurinol. The result of meta-analysis also showed consistent result. In conclusion, the incidence and severity of febuxostat-hypersensitivity are lower than with allopurinol. Febuxostat didn't show an increased risk of CVD and related death. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalClinical Pharmacology and Therapeutics
DOIs
Publication statusE-pub ahead of print - Jan 28 2019

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Chen, C-H., Chen, C-B., Chang, C. J., Lin, Y. J., Wang, C-W., Chi, C-C., Lu, C-W., Chen, W-T., Pan, R-Y., Su, S-C., Hsu, L-A., Chang, Y-C., Yu, K-H., Wu, Y-J. J., Lin, K-M., Hung, S-I., Chen, S-M., & Chung, W-H. (2019). Hypersensitivity and cardiovascular risks related to allopurinol and febuxostat therapy in Asians: A population-based cohort study and meta-analysis. Clinical Pharmacology and Therapeutics. https://doi.org/10.1002/cpt.1377