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This comparative effectiveness clinical trial was undertaken to compare first\u2010line nontitrated low\u2010dose benzbromarone (LDBen) uricosuric therapy to XOI ULT with low\u2010dose febuxostat (LDFeb) in gout patients with renal uric acid underexcretion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective, randomized, single\u2010center, open\u2010label trial in men with gout and renal uric acid underexcretion (defined as fractional excretion of urate &lt;5.5% and uric acid excretion \u2264600 mg\/day\/1.73 m<jats:sup>2<\/jats:sup>). A total of 196 participants were randomly assigned to receive LDBen 25 mg daily or LDFeb 20 mg daily for 12\u2009weeks. All participants received daily urine alkalization with oral sodium bicarbonate. The primary end point was the rate of achieving the serum urate target of &lt;6 mg\/dl.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>More participants in the LDBen group achieved the serum urate target than those in the LDFeb group (61% compared to 32%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Rates of adverse events, including gout flares and urolithiasis, did not differ between groups, with the exception of greater transaminase elevation in the LDFeb group (4% for LDBen compared to 15% for LDFeb, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.008).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared to LDFeb, LDBen has superior urate\u2010lowering efficacy and similar safety in treating relatively young and healthy patients with renal uric acid underexcretion\u2013type gout.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.42266","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T03:01:39Z","timestamp":1657162899000},"page":"2015-2023","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Superiority of <scp>Low\u2010Dose<\/scp> Benzbromarone to <scp>Low\u2010Dose<\/scp> Febuxostat in a Prospective, Randomized Comparative Effectiveness Trial in Gout Patients With Renal Uric Acid Underexcretion"],"prefix":"10.1002","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3381-1489","authenticated-orcid":false,"given":"Fei","family":"Yan","sequence":"first","affiliation":[{"name":"Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and Gout  Qingdao China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1430-0130","authenticated-orcid":false,"given":"Xiaomei","family":"Xue","sequence":"additional","affiliation":[{"name":"Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and Gout  Qingdao China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2886-8285","authenticated-orcid":false,"given":"Jie","family":"Lu","sequence":"additional","affiliation":[{"name":"Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout and Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, Institute of Metabolic Diseases, Qingdao University, and China Shandong Provincial Clinical Research Center for Immune Diseases and Gout  Qingdao 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