Comparative efficacy and safety of uricosuric agents in the treatment of gout or hyperuricemia: a systematic review and network meta-analysis,Clinical Rheumatology

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Comparative efficacy and safety of uricosuric agents in the treatment of gout or hyperuricemia: a systematic review and network meta-analysis
Clinical Rheumatology ( IF 2.9 ) Pub Date : 2022-08-29 , DOI: 10.1007/s10067-022-06356-z
Ya-Jia Li ₁ , Li-Rong Chen ₁ , Zhong-Lei Yang ₁ , Ping Wang ₁ , Fang-Fang Jiang ₁ , Yu Guo ₁ , Kai Qian ₁ , Mei Yang ₁ , Sun-Jun Yin ₁ , Gong-Hao He ₁

Affiliation

Objectives

The current world witnesses a greatly increased prevalence and incidence of hyperuricemia and gout with unfortunately the comparative efficacy and safety of present available uricosuric agents remaining uncertain. We herein aimed to investigate the most appropriate uricosuric agent for gout or hyperuricemia patients.

Method

PubMed, Embase, Cochrane Library databases, and ClinicalTrials.gov from inception to 2 July 2022 were searched to retrieve eligible studies assessing efficacy and safety of uricosuric drugs in hyperuricemia or gout patients. Network meta-analysis was carried out using the Stata 16.0 software.

Results

Twelve randomized controlled trials comprising 1851 patients were eventually included. Network meta-analysis showed that dotinurad 4 mg once daily, verinurad, dotinurad 2 mg once daily, dotinurad 1 mg once daily, and benzbromarone were the top 5 effective treatments to achieve target serum uric acid. Furthermore, dotinurad 4 mg once daily was more effective at achieving urate-lowering targets (RR of dotinurad 4 mg once daily vs. probenecid: 1.68, 95% CI [1.13; 2.50]) and safer (RR of probenecid vs. dotinurad 4 mg once daily: 1.77, 95% CI [0.69; 4.56]) than probenecid.

Conclusions

This network meta-analysis demonstrated an important absolute benefit of dotinurad 4 mg once daily to achieve target serum uric acid and low risk of adverse events for drug treatment of gout or hyperuricemia patients. Additionally, verinurad might be used as an alternative uricosuric therapeutic option to dotinurad. These findings provided further comprehensive insight into the treatment value of current uricosuric agents for gout or hyperuricemia.

Key Points
1. This is the first systematic review and network meta-analysis examining the efficacy and safety of currently available uricosuric agents in gout or hyperuricemia patients.
2. Recommended doses of dotinurad 4mg once daily used for the treatment of gout or hyperuricemia patients can significantly decrease serum uric acid levels.
3. The present findings will provide further comprehensive insight into the treatment value of certain uricosuric agents for gout or hyperuricemia.

中文翻译：

降尿酸药治疗痛风或高尿酸血症的疗效和安全性比较：一项系统评价和网络荟萃分析

目标

当今世界见证了高尿酸血症和痛风的患病率和发病率大大增加，不幸的是目前可用的排尿酸药物的相对疗效和安全性仍然不确定。我们在此旨在研究最适合痛风或高尿酸血症患者的排尿酸药物。

方法

搜索了 PubMed、Embase、Cochrane 图书馆数据库和 ClinicalTrials.gov 从成立到 2022 年 7 月 2 日的数据，以检索符合条件的研究，这些研究评估了排尿酸药物在高尿酸血症或痛风患者中的疗效和安全性。使用Stata 16.0软件进行网络荟萃分析。

结果

最终纳入了包含 1851 名患者的 12 项随机对照试验。网络荟萃分析显示，dotinurad 4 mg 每天一次、verinurad、dotinurad 2 mg 每天一次、dotinurad 1 mg 每天一次和苯溴马隆是实现目标血尿酸的前 5 种有效治疗方法。此外，dotinurad 4 mg 每天一次在实现尿酸降低目标方面更有效（dotinurad 4 mg 每天一次与丙磺舒的 RR：1.68，95% CI [1.13；2.50]）并且更安全（丙磺舒与 dotinurad 4 mg 的 RR）每天一次：1.77，95% CI [0.69; 4.56]) 比丙磺舒。