Gout Pharmacotherapy in Cardiovascular Diseases

A Review of Utility and Outcomes

Subuhi Kaul; Manasvi Gupta; Dhrubajyoti Bandyopadhyay; Adrija Hajra; Prakash Deedwania; Edward Roddy; Mamas Mamas; Allan Klein; Carl J. Lavie; Gregg C. Fonarow; Raktim K. Ghosh

Disclosures

Am J Cardiovasc Drugs. 2021;21(5):499-512. 

In This Article

Future Directions

Newer drugs are emerging for the treatment of gout and it is too early to comment on their effect on CV morbidity or mortality. A phase I study has shown that a selective uric acid reabsorption inhibitor called verinurad lowered serum urate without any major adverse effects in healthy males, but unclear CV safety.[55]

Another potential drug class, IL-1 antagonist therapy, is being evaluated in current trials. A recent animal study showed beneficial cardiac effects of anakinra on the myocardium, while rilonacept, a newer IL-1 antagonist, has limited data regarding the CV safety.[56] Arhalofenate, a partial agonist on peroxisome proliferator-activated receptor (PPAR)-γ was initially developed as an antidiabetic drug and was serendipitously found to have modest uric acid-lowering properties in addition to anti-ILβ activity. A randomized, double-blind study on arhalofenate did not reveal any specific CV adverse effect, but more research is required.[57] Several ongoing studies on gout therapies are listed in Table 3 and Table 4.

Sodium glucose cotransporter (SGLT)-2 inhibitors, a prominent antidiabetic drug class with extended benefit in HF patients, have also shown a reduction in serum uric acid levels, which could contribute to the CV mortality benefit seen with this class of drugs. By increasing renal urate losses, this drug class decreases serum uric by about 0.60–0.75 mg/dL, making it a potential add-on agent for use in patients with diabetes and hyperuricemia. Several randomized studies have reported a decrease in MACE and HF rehospitalization with SGLT-2 inhibitors.[58]

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