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Gout Dugout.Issue #065. wine and gout study | lesinurad | removing kidney stones
March 29, 2014
Hello and Welcome to the Spring (late March) 2014, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read that gives you ideas that may help with your gout. Copy and print if you prefer to read a version on paper. If you are extra busy now, you could save it for later.
WINE AND GOUT – EVIDENCE THAT WINE IS A GOUT CAUSE
Uric acid was linked to gout in the later 1700’s but doctors didn’t know its true role until the 1850’s – 1860’s, and purines themselves were not known until the late 1800’s. However, wine was correctly seen to be one of the gout culprits much earlier from peoples’ self-observation. These days, if you have gout, the conventional wisdom about wine, beers and spirits (liquor), is do not have more than one or two drinks a day. But there are conflicting studies about wine and gout and just how bad for gout is wine, is not clear cut.
A recently published U.S. study of 724 gout sufferers (78% male) (1) confirmed that the conventional wisdom about how much a gout sufferer can drink, is about right. Among gout patients – they had suffered at least one attack in the previous year - the study found that one drink a day (12 ounces beer, 5 ounces wine and 1 1/2 of spirits (liquor)) did not have much of a causal effect on subsequent gout attacks. But above one to two and the risk of an attack rose by 36%; two to four, and the risk rose 51%; above four, and the risk rose still further.
Mirage by Carlos Porte
So one daily glass of alcohol is enough, perhaps two, but maybe not wine. Read on.
Gout and wine Now here is something which is contrary to what you usually hear. The effects of wines, beers and spirits (liquor) were compared in the study. It turned out that wine had a much higher risk of gout attacks – more than one and up to two glasses more than doubled the risk – 138% compared to not drinking wine. And beer and gout? Two to four beers raised it by less than wine, by three quarters (75%), compared to not drinking beer. That is surprising.
This study was mainly among men, there were not enough women to be sufficiently accurate about them, except the lead researcher, Dr.Tuhima Neogi, said women surveyed showed a similar pattern to the men. She had been motivated to do the study because she had heard so many of her patients saying that wine had triggered their gout attacks.
However, I don’t think uric acid levels were tested, so no correlation could be found between their various alcohol intakes and uric acid levels. Nor other gout related behaviour such as exercise and dietary efforts with food.
So what should you think and do? If for one second you suspect wine, beer or spirits (liquor) is a cause of your gout attacks, then give them up or reduce to one a day, the amount this study says is probably safe. However difficult that may be. It’s simply not worth it at any stage of gout. Think long term. Gout will get worse, and you must control it. Doing this without a daily med, by diet and exercise if you can, is the best way.
FORMER FRENCH PRESIDENT HAS GOUT
The disease of Kings? Or is that of Presidents and other leaders? Yuri Andropov, a KGB boss and later Soviet communist party General Secretary in the 1980’s suffered gout. So does ex U.S. Vice President Dick Cheney who also had one of the classic gout accompaniments, heart disease.
Now we hear that former French President Jacques Chirac, was rushed to hospital recently for a gout attack. He is 81, and last December underwent successful kidney surgery. Kidney disease of course is another classic gout bedfellow when it causes less uric acid to be excreted. He also had a stoke a few years ago. They probably gave him a corticosteroid shot for the pain.
Is a job as a food writer/presenter a high risk occupation for gout? I can think of two well known food writers who have got it. Now we read there’s a third. It’s Dave Myers, one of the Hairy Bikers – celebrity chef/media reporters-presenters - who in their best known series travelled around Great Britain to each county cooking the county’s signature dish from local ingredients – and accompanied by his fellow hairy biker Simon (Si) King.
Somewhat like the hugely successful Two Fat Ladies which was shown on T.V. throughout the Anglosphere. Myers’s gout didn’t stop him also appearing on a T.V. dance show Strictly Come Dancing, DURING a gout attack. That really takes some fortitude, few would have done it, but Dave Myers did. Take a bow Dave. The Hairy Bikers are currently on their Asian Adventure and are now also on a diet. Seems Myers has got the massage.
Or how about a job as an actor who has to put on weight for a part? That’s happened to U.S. actor Jared Leto who put on 67 lbs to play Mark Chapman, the killer of John Lennon in Chapter 27. Then he announced he had gout. Now he has lost the weight, but the gout will always have to be controlled.
Lesinurad, is in Phase three trials and their final results should be announced in June. I have written about it before, when was called RDEA594. It is a drug that lowers uric acid by encouraging its excretion.
There has been an emphasis on trialing Lesinurad with allopurinol and febuxostat. In theory that ought to be very good at lowering uric acid, both blocking production and encouraging excretion. A double whammy. Some reports have said it could be a blockbuster. Others have been more cautious and have pointed to adverse effects, including serious ones in the last trial (see below).
Huge pharma company AstraZeneca PLC paid a lot of money for Ardea Biosciences - 54% above the last share price - a couple of years ago to buy Ardea and its main drug under development Lesinurad, so they were pretty confident that it will gain approval.
In one trial a few years ago, at the higher RDEA594 (Lesinurad) dosage (400 mg) and 40 mg of Febuxostat, average serum uric acid (urate) levels fell to just 1.2 mg/dL,(71.4 µmol/L). The lowest uric acid level I've heard of up to then from a drug’s reduction was 2.0 mg/dL, so this is low.
The most recent Lesinurad trial results were released in December last year. In this trial it was tested standalone amongst 214 gout patients (400 mg daily dose) who were unable to take allopurinol or febuxostat. Their average (serum) blood uric acid level was 9.3. mg/dL, pretty high but could be worse. It met its target for the number of these patients who got the uric acid down to below the important 6.0 mg/dL level.
But AstraZeneca reported increased risk of adverse kidney events including some that were described as serious. But that may be a consequence of the dose, or trialists kidneys’ condition, or other acceptable reasons. AstraZeneca have not yet said. We shall see.
Lesinurard is a promising gout drug. At the present time the last of its Phase 3 trials are being conducted. There are three of them, two among patients who did not get uric acid down with allopurinol and febuxostat and one in combo with febuxostat among tophi patients. The results are due to be announced in mid 2014, which may be by end June. At that point we should learn more about the adverse events. I’ll cover this in the June issue if the results are out by then.
AstraZeneca (AZ) say they will apply for Lesinurad’s approval in the U.S. and in EU nations in the second half of 2014. If it succeeds it will be a big gout event. AZ say Japan and China are also targeted for early approval too, presumably after the U.S. and EU countries.
The UASure is a DIY home uric acid test kit. It measures the level of uric acid in the blood. Click on the link below to visit a company who can ship it world-wide, including to the United States and Canada, from Britain.
KIDNEY STONES – NEW TREATMENT MAKES REMOVAL EASIER
About 20-25% of gout sufferers get kidney stones sooner or later, often of the uric acid crystals variety, wholely or partly. So when I saw this the other day I couldn’t resist putting a link here. Doctors may soon be able to remove kidney stones more quickly in just one procedure.
This is probably not yet available in your country, and I don’t know whether this new treatment is a world first, or just a U.K. first. But this is just so that you know.
Search - bilateral simultaneous ureteroscopy - the clumsy, esoteric name for the procedure. Or
Read this story if you're interested.
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Go to the www.best-gout-remedies.com home page by clicking on the link below.
NO NEWS FROM KRYSTEXXA’S NEW OWNERS IS NEWS
I must write the only newsletter where no news is made news! You might have been wondering if there is any news about Krystexxa. So have I, but so far nothing. Just saying this so that you know it hasn't been forgotten - Krystexxa is an important medication for gout.
Its new owners, Crealta Pharmaceuticals, are clearly having a long look at its prospects and how to develop it outside the U.S.
Use the website's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. There are currently around 215 pages, including all the back issues of this newsletter. It works. Use it!
Next issue – towards the end of June.
Thanks for reading, and all the best of health.
John Mepham BA (Econ).
(1) Alcohol quantity and type on risk of recurrent gout attacks: An internet-based case-crossover study. Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ, Zhang Y. The American Journal of Medicine 2014 Jan 16. pii: S0002-9343(14)00032-1. doi: 10.1016/j.amjmed.2013.12.019. [Epub ahead of print].
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