A NEW study has revealed that obesity significantly diminishes the efficacy of urate-lowering therapy (ULT) with febuxostat in male patients with primary gout. The prospective cohort study suggests that while overweight does not substantially impact treatment outcomes, obesity poses a significant barrier to achieving target serum urate (SU) levels.
The study, which involved 633 male gout patients, categorised participants based on their body mass index (BMI) into normal-weight, overweight, and obese groups. All participants received febuxostat treatment for 12 weeks, with the dosage gradually increased from 20 mg to 40 mg daily. Researchers compared the treatment efficacy and incidence of gout flares across these groups.
Results showed that only 38.9% of obese patients achieved the target SU level of less than 6.0 mg/dl, compared to 54.2% of overweight patients and 63.8% of normal-weight patients. The difference between overweight and normal-weight groups was not statistically significant. Cox regression analysis identified high BMI as an independent risk factor for failing to achieve the SU target, with a hazard ratio (HR) of 0.92.
Additionally, obese and overweight patients experienced a higher incidence of gout flares compared to their normal-weight counterparts. The relationship between BMI and the likelihood of achieving SU targets was confirmed through restricted cubic spline curves, indicating a linear but significant impact of obesity on treatment success.
“Our findings highlight the need for weight management as an integral part of gout treatment, especially for obese patients,” the researchers concluded. “Addressing obesity might enhance the effectiveness of urate-lowering therapy and reduce the frequency of gout flares.”
Aleksandra Zurowska, EMJ
Reference
Cheng Z et al. Obesity reduces the urate-lowering efficacy among patients with primary gout: a prospective cohort study, Rheumatology. 2025;DOI: 10.1093/rheumatology/keaf076.
