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.
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Disclosure of Interest None declared