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Cardiovascular outcomes of urate-lowering therapies in patients with gout or hyperuricemia: a network meta-analysis

Yilong Yan1,2, Ying Bai1, Jiawei Wang1

  • 1Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.

Expert Opinion on Drug Safety
|November 14, 2024
PubMed

Insights

Urate-lowering therapies (ULTs) generally show good cardiovascular safety for gout patients. Allopurinol reduced arrhythmia risk compared to febuxostat, though overall differences were not significant.

Area of Science:

  • Cardiology
  • Pharmacology
  • Rheumatology

Background:

  • Gout and hyperuricemia management often involves urate-lowering therapies (ULTs).
  • Assessing the cardiovascular safety of various ULTs is crucial for patient care.
  • Comparative safety data for ULTs is essential for clinical decision-making.

Purpose of the Study:

  • To evaluate and compare the cardiovascular safety of different urate-lowering therapies (ULTs).
  • To analyze the risk of major adverse cardiovascular events (MACEs) and mortality associated with ULTs.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) reporting cardiovascular outcomes.
  • Pairwise and network meta-analyses were conducted to determine odds ratios (ORs) and 95% confidence intervals (CIs).
  • Surface Under the Cumulative Ranking Curve (SUCRA) was used to rank ULTs by cardiovascular safety.

Main Results:

  • Allopurinol significantly reduced arrhythmia risk compared to febuxostat (OR 0.69-0.71).
  • No statistically significant differences in other cardiovascular outcomes were observed between ULTs or against placebo.
  • Febuxostat and pegloticase showed the highest probability for mitigating MACEs and all-cause mortality, respectively.

Conclusions:

  • Overall, urate-lowering therapies demonstrate favorable cardiovascular safety profiles in patients with gout or hyperuricemia.
  • Febuxostat may carry a higher risk of arrhythmia compared to allopurinol.
  • Further research is warranted to validate these comparative cardiovascular safety findings.
Abstract

Keywords:
Cardiovascular safetygouthyperuricemiameta-analysisurate-lowering therapies

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