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Lancet reports the results of the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study - where fenofibrate was shown to reduce uric acid by 20%, gout events by nearly 50% and may be useful in preventing gout in diabetes.
In the study, 9795 adults (age 50–75 years) with type 2 diabetes were randomized to receive fenofibrate 200 mg per day or placebo and followed for up to 5 years.
In the fenofibrate group, serum uric acid levels fell by 20·2% during a 6-week active fenofibrate run-in period (a reduction of 0·06 mmol/L or 1 mg/dL) and remained −20·1% (p<0·0001) lower for those re-measured at 1 year.
First new gout events were seen in 3% of placebo and 2% of fenofibrate patients during 5 years of follow-up (HR 0·54, 95% CI 0·41–0·70; p<0·0001).
Cumulative gout attacks were higher In the placebo group based on baseline uric acid concentration (7·7% or 13.9% if higher than 0·36 mmol/L or 0·42 mmol/L) versus only 3·4% or 5·7% in the fenofibrate group.
Analyzing all gout events, fenofibrate reduced the risk of gout events by 52% (HR 0·48, 95% CI 0·37–0·60; p<0·0001) compared with placebo.
Previous small and short term studies have shown fenofibrate to lower uric acid and reduces gout attacks. The current study shows a sustained 20% reduction in uric acid levels that translates to fewer cases of incident gout in those with diabetes.