Experience with a new uricosuric drug (dotinurad)

Abstract

A uricosuric drug, which is an inhibitor of urate transporter 1 (URAT1), increases urinary uric acid excretion, leading to a uric acid-lowering effect. The uricosuric drugs probenecid and benzbromarone also inhibit other transporters involved in uric acid transport in addition to URAT1, but dotinurad, which can specifically inhibit URAT1 without affecting other transporters, has come to be used in clinical practice. One hundred and eight gout / hyperuricemia patients who were able to achieve a serum uric acid level of 6 mg / dL or lower by the administration of dotinurad from January to September 2021, were selected as new administration cases. In the same period, 113 patients who changed their treatment from benzbromarone to dotinurad were selected as alteration cases. In both cases, the uric acid control status on dotinurad administration was retrospectively examined. In order to achieve the therapeutic target of a serum uric acid level of 6 mg / dL or lower, the higher the serum uric acid level before administration, the higher the dose of administration. The dose required to achieve the serum uric acid target value was 0.5 mg in 44 cases (40.7%), 1 mg in 40 cases (37.0%), 2 mg in 17 cases (15.7%), 3 mg in 6 cases (5.6%), and 4 mg in 1 case (0.9%), and nearly 80% of patients achieved the target value within a dose of 1 mg. In the alteration cases, the serum uric acid level significantly decreased from 5.7 ± 1.2 to 5.4 ± 1.0 mg / dL. Furthermore, there was a significant decrease from 5.9 ± 1.2 to 5.5 ± 1.1 mg / dL in patients with a decreased renal function (eGFR <60 mL / min / 1.73 m²). These results suggest that dotinurad has a stronger uric acid-lowering effect than benzbromarone, and the effect may be marked in patients with an impaired renal function.