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Meta-Analysis
. 2021 Feb;40(2):683-692.
doi: 10.1007/s10067-020-05272-4. Epub 2020 Jul 11.

Comparison of efficacy and safety of urate-lowering therapies for hyperuricemic patients with gout: a meta-analysis of randomized, controlled trials

Meida Fan #  1   2 , Jian Liu #  3 , Bingcheng Zhao  3 , Xinyu Wu  2 , Xuefeng Li  4   5   6 , Jieruo Gu  7 , Naomi Schlesinger  8
Affiliations
Meta-Analysis

Comparison of efficacy and safety of urate-lowering therapies for hyperuricemic patients with gout: a meta-analysis of randomized, controlled trials

Meida Fan et al. Clin Rheumatol. 2021 Feb.

Abstract

Objectives: To assess the efficacy and safety of the commonly used urate-lowering therapies (ULTs): febuxostat, allopurinol, and lesinurad in hyperuricemic patients with gout.

Methods: We included all randomized controlled trials (RCTs) that compared ULTs with placebo or head to head. The primary efficacy endpoint was the proportion of subjects achieving the target serum urate (SU) level at month 6. Safety outcomes included total adverse events (AEs), serious AEs, withdrawals due to AEs, and AEs per organ system. A Bayesian network model was used to compare all ULTs with placebo and among themselves.

Results: Fifteen RCTs were included for the analysis, in which 7968 patients were randomly assigned to take either placebo or one of 11 ULTs: allopurinol, febuxostat 40/80/120/240 mg/day, lesinurad 400 mg/day, lesinurad 200/400/600 mg/day plus allopurinol, and lesinurad 200/400 mg/day plus febuxostat. All ULTs were effective in achieving the target SU level at month 6 compared with placebo (ORs between 26.81 and 1928). Febuxostat 80/120/240 mg/day was superior to allopurinol and well tolerated for urate reduction. And as febuxostat dosage increased, more patients achieved the target SU level. Furthermore, the lesinurad combination with xanthine oxidase inhibitor (XOI) groups had a higher proportion of patients achieving the target SU level than the febuxostat 40 mg/day group (ORs between 2.89 and 9.17), the allopurinol group (ORs between 3.56 and 11.27), or the lesinurad 400 mg/day monotherapy group (ORs between 12.30 and 39.17) but might have a high risk of AEs.

Conclusions: All ULTs are effective in achieving the target SU level compared with placebo in hyperuricemic patients with gout. Lesinurad in combination with febuxostat or allopurinol is effective in urate lowering, especially for patients with inadequate response to XOI monotherapy. Key Points • All urate-lowering therapies (ULTs) were effective in achieving the target serum urate (SU) level at month 6 compared with placebo in hyperuricemic patients with gout. • Febuxostat 80/120/240 mg/day was superior to allopurinol and well tolerated for urate reduction. And as febuxostat dosage increased, more patients achieved the target SU level. • Lesinurad in combination with febuxostat or allopurinol was effective in urate lowering, especially for patients with inadequate response to xanthine oxidase inhibitor monotherapy, but might have a high risk of AEs.

Keywords: Allopurinol; Febuxostat; Gout; Hyperuricemia; Lesinurad; Meta-analysis.

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References

    1. Hamburger M, Baraf HS, Adamson TC 3rd, Basile J, Bass L, Cole B, Doghramji PP, Guadagnoli GA, Hamburger F, Harford R, Lieberman JA 3rd, Mandel DR, Mandelbrot DA, McClain BP, Mizuno E, Morton AH, Mount DB, Pope RS, Rosenthal KG, Setoodeh K, Skosey JL, Edwards NL (2011) 2011 recommendations for the diagnosis and management of gout and hyperuricemia. Phys Sportsmed 39(4):98–123 - PubMed
    1. Jia E, Zhu J, Huang W, Chen X, Li J (2018) Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout. Clin Rheumatol 37(3):773–777 - PubMed
    1. Xu L, Liu S, Guan M, Xue Y (2016) Comparison of prednisolone, etoricoxib, and indomethacin in treatment of acute gouty arthritis: an open-label, randomized, controlled trial. Med Sci Monit 22:810–817 - PubMed - PMC
    1. Puig JG, de Miguel E, Castillo MC, Rocha AL, Martinez MA, Torres RJ (2008) Asymptomatic hyperuricemia: impact of ultrasonography. Nucleosides Nucleotides Nucleic Acids 27(6):592–595 - PubMed
    1. Ioachimescu AG, Brennan DM, Hoar BM, Hazen SL, Hoogwerf BJ (2008) Serum uric acid is an independent predictor of all-cause mortality in patients at high risk of cardiovascular disease: a preventive cardiology information system (PreCIS) database cohort study. Arthritis Rheum 58(2):623–630 - PubMed

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