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AB0819 Indirect Comparison of Urate-Lowering Therapies for Hyperuricemic Patients with or without Gout: Meta-Analysis of Randomized Controlled Trials
  1. M. Fan1,
  2. J. Liu2,
  3. B. Zhao2,
  4. X. Wu1,
  5. J. Gu1
  1. 1the third affiliated hospital of Sun Yat-Sen University
  2. 2the first affiliated hospital of sun yat-sen university, Guangzhou, China

Abstract

Background Hyperuricemia is the most significant risk factor for the development of gout, defined as a serum concentration of uric acid at 6.8 mg/dl or greater. Long-term maintenance of serum urate levels below its saturation threshold can reduce the frequency of acute gout flares and resolve the existing tophi.

Objectives To assess the urate-lowering efficacy and safety of febuxostat, allopurinol and benzbromarone in hyperuricemic patients with or without gout.

Methods We included all the randomized controlled trials (RCTs) that compared any urate-lowering medication with placebo or head to head. The efficacy outcomes included the proportions of achieving the target urate level (<6.0 mg/dl) at final visit or last 3 visits and the percentage of gout flares during the first 8 weeks. The safety outcomes included total adverse events (AEs), withdrawals due to AEs and serious AEs. A Bayesian network model was used to compare all interventions simultaneously.

Results Sixteen RCTs (6645 patients) were included in the analysis. All urate-lowering therapies were more likely to achieve the target urate level at final visit and last 3 visits than placebo, but had an inconclusive higher risk of gout flares. Furthermore, all of the febuxostat doses (40, 80, 120, 240 mg/day) had a higher proportion of achieving the target urate level at final visit than allopurinol. With febuxostat dosages increased, more patients achieved the target urate level. Febuxostat 240 mg/day was the most effective drug for serum urate normalization. Regarding safety, there were no significant differences among urate-lowering therapies and placebo for total AEs, withdrawals due to AEs and serious AEs, except that allopurinol had a higher risk of total AEs than febuxostat 120mg/day.

Conclusions Compared to placebo, all urate-lowering therapies are effective in achieving the target urate level for hyperuricemic patients. Febuxostat is more efficacious than allopurinol for serum urate normalization.

  1. Hamburger M, Baraf HS, Adamson TC, 3rd, et al. 2011 recommendations for the diagnosis and management of gout and hyperuricemia. The Physician and sportsmedicine 2011;39(4):98–123.

  2. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis care & research 2012;64(10):1431–46.

  3. Perez-Ruiz F, Liote F. Lowering serum uric acid levels: what is the optimal target for improving clinical outcomes in gout? Arthritis and rheumatism 2007;57(7):1324–8.

Disclosure of Interest None declared

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