{"doi":"10.1002/art.42499","title":"Superiority of low‐dose benzbromarone to low‐dose febuxostat in gout patients with renal uric acid underexcretion: comment on the article by Yan et al","abstract":"Yan et al conducted a randomized trial to compare low-dose benzbromarone (LDBen) to low-dose febuxostat (LDFeb) in men with gout and renal uric acid underexcretion (1). Superiority of LDBen was observed with regard to achievement of a serum urate target under 6 mg/dl (61% compared to 32% for LDFeb). In addition, there was a significant transaminase elevation in the LDFeb group (15% compared to 4% for LDBen). There was no significant difference in the rates of gout flares and urolithiasis, and the authors recommended low-dose benzbromarone in this situation. I have some comments about their study. Another randomized controlled study from China (2) compared the efficacy and safety of the 2 urate-lowering drugs at the same doses and duration of treatment as used in Yan et al. There was no significant difference in the rates of achieving the serum urate target and adverse events in the Liang et al study (2). Those authors mentioned that serum urate level and renal function might become key factors for selecting either LDBen or LDFeb. I understand that there is an ethnic difference in the rate of renal uric acid underexcretion in gout patients. In the Liang et al study (2), the incidence of gout flares in the LDFeb and LDBen groups was 22.85% and 33.94%, respectively, and the mean age of participants was >50 years. I think that continuous surveys are needed to specify the safety and efficacy of 2 different types of medication. Regarding the effect of clinical hyperuricemia typing (CHT) on the efficacy of urate-lowering therapy, Xue et al reported that percentages of gout patients with the underexcretion type and those with the unclassified type achieved 60.5% and 39.0% of the target serum urate level, respectively, following treatment with LDBen (3). In addition, blood glucose and cholesterol levels were lower in those with the underexcretion type compared to those with the unclassified type at the end of the trial. Since the prognosis was better in gout patients with the underexcretion type in the Xue et al study, CHT may be important for specifying the superiority of medication for gout. Finally, the data from the Xue et al study were derived from Chinese male participants. Ethnic and sex differences in the efficacy of urate-lowering therapy should be examined using randomized controlled studies. Furthermore, Xue et al focused on gout patients with the underexcretion type, and there was an advantage of LDBen treatment over LDFeb treatment. Disclosure Form Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.","journal":"Arthritis & Rheumatology","year":2023,"id":387965,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9509,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":426389,"name":"Tomoyuki Kawada","orcid":"0000-0002-4426-4644","position":0,"is_corresponding":true}],"reference_count":3,"raw_metadata":null,"created_at":"2026-07-19T01:18:13.977537Z","pmid":"36908047","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}