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Randomized Controlled Trial
. 2023 Oct;37(5):965-974.
doi: 10.1007/s10557-022-07347-7. Epub 2022 Jun 1.

C-reactive Protein Levels and Cardiovascular Outcomes After Febuxostat Treatment in Patients with Asymptomatic Hyperuricemia: Post-hoc Analysis of a Randomized Controlled Study

Sunao Kojima  1 , Kazuaki Uchiyama  2 , Naoto Yokota  3 , Eiichi Tokutake  4 , Yutaka Wakasa  5 , Shinya Hiramitsu  6 , Masako Waki  7 , Hideaki Jinnouchi  8 , Hirokazu Kakuda  9 , Takahiro Hayashi  10 , Naoki Kawai  11 , Masahiro Sugawara  12 , Hisao Mori  13 , Kenichi Tsujita  14 , Kunihiko Matsui  15 , Ichiro Hisatome  16 , Yusuke Ohya  17 , Kazuo Kimura  18 , Yoshihiko Saito  19 , Hisao Ogawa  20 ; Febuxostat for Cerebral and CaRdiorenovascular Events PrEvEntion StuDy (FREED) investigators
Affiliations
Randomized Controlled Trial

C-reactive Protein Levels and Cardiovascular Outcomes After Febuxostat Treatment in Patients with Asymptomatic Hyperuricemia: Post-hoc Analysis of a Randomized Controlled Study

Sunao Kojima et al. Cardiovasc Drugs Ther. 2023 Oct.

Abstract

Purpose: Inflammation plays an important role in the initiation and progression of atherosclerosis, leading to poor clinical outcomes. Hyperuricemia is associated with the activation of the Nod-like receptor protein 3 inflammasome. Here, we investigated whether inhibition of inflammation using febuxostat lowered the risk of cardiovascular events.

Methods: This is a post-hoc analysis of the randomized trial, Febuxostat for Cerebral and CaRdiorenovascular Events PrEvEntion StuDy (FREED). In total, 1067 patients (736 men and 331 women) were included in the analysis. We compared the serial changes in high-sensitivity C-reactive protein (hs-CRP) levels between febuxostat and non-febuxostat groups and assessed the correlation between the changes in uric acid (UA) and hs-CRP levels after febuxostat treatment. We also determined whether febuxostat could reduce a hard endpoint, defined as a composite of cardiovascular events and all-cause mortality.

Results: Serum UA levels in the febuxostat group were significantly lower than those in the non-febuxostat group after randomization (p < 0.05). However, hs-CRP levels were comparable between the two groups during the study. No significant correlation was observed between the changes in UA and hs-CRP levels after febuxostat treatment. The hard endpoints did not differ significantly between the two groups. In patients with baseline hs-CRP levels > 0.2 mg/dL or those administered 40 mg of febuxostat, the drug did not reduce hs-CRP levels or decrease the hard endpoint.

Conclusion: Febuxostat reduced the UA levels but did not affect the CRP levels, and therefore may fail to improve cardiovascular outcomes after treatment.

Trial registration: ClinicalTrial.gov (NCT01984749). https://clinicaltrials.gov/ct2/show/NCT01984749.

Keywords: CRP; Febuxostat; Hyperuricemia; Inflammation; Uric acid; XOI.

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