Kojima S, Uchiyama K, Yokota N, et al. - In patients with asymptomatic hyperuricemia, optimal serum uric acid (SUA) concentrations by febuxostat therapy is 5–6 mg/dl for decreasing all-cause death, cerebral, cardiovascular, and renal events. In older hyperuricemic individuals, excessive SUA reduction may be detrimental.

• A randomized trial (Febuxostat for Cerebral and CaRdiorenovascular Events PrEvEntion StuDy [FREED]) assigned 1070 older patients with asymptomatic hyperuricemia to febuxostat (n = 537) or non-febuxostat treatment group (n = 533).

• In this post hoc analysis of the abovementioned trial, the link between the endpoint (withdrawal or study completion) SUA levels and clinical results was examined.

• A composite of all-cause mortality, cerebral and cardiorenovascular events was the primary endpoint.

• Significantly higher risks for a primary composite event were observed in patients in the febuxostat group who achieved SUA levels ≤4 mg/dl (hazard ratio: 2.01), >4 to ≤ 5 mg/dl (2.12), >6 to ≤ 7 mg/dl (2.42), and >7 mg/dl (4.73) vs those achieving SUA levels >5 to ≤ 6 mg/dl.

• This J-shaped association applied to cases with renal damage and was not significant in the non-febuxostat treatment group.