Drugs Real World Outcomes. 2025 Nov 27. doi: 10.1007/s40801-025-00526-6. Online ahead of print.
ABSTRACT
BACKGROUND: Hyperuricemia is a common comorbidity in patients with cardiovascular diseases and chronic kidney disease, often requiring long-term urate-lowering therapy. Febuxostat, a xanthine oxidase inhibitor, has raised cardiovascular safety concerns. Dotinurad, a selective urate reabsorption inhibitor, has emerged as a potential alternative, but clinical evidence in patients with Stage B/C heart failure remains limited.
METHODS: This single-center retrospective study evaluated 30 patients with Stage B (n = 10) and C (n = 20) heart failure and hyperuricemia who were switched from febuxostat (10, 20, or 40 mg) to dotinurad (0.5, 1.0, or 2.0 mg, respectively), based on the prior febuxostat dose. Laboratory and urinary parameters were assessed at baseline and at follow-up (median 65 days [56-84] after switching).
RESULTS: In Stage B heart failure, serum uric acid showed a non-significant trend toward reduction (5.8 [4.4-6.3] to 5.3 [4.8-7.5] mg/dL, p = 0.09), whereas in Stage C heart failure, serum uric acid increased significantly (5.1 [4.6-6.6] to 5.4 [4.8-6.8] mg/dL, p = 0.02). The proportion of patients achieving serum uric acid ≤ 6.0 mg/dL was maintained (Stage B: 60.0 to 50.0%; Stage C: 70.0 to 75.0%). Urinary uric acid excretion increased, while urinary pH remained stable in both groups. The uricosuric effect of dotinurad was evident with or without concomitant use of sodium-glucose cotransporter 2 inhibitors. No adverse events, including cardiovascular events, urolithiasis, or gout flares, were observed.
CONCLUSIONS: Switching from febuxostat to dotinurad may be effective and safe over the short term in patients with Stage B/C heart failure and hyperuricemia.
PMID:41307868 | DOI:10.1007/s40801-025-00526-6