Topiroxostat-A Safer Uricostatic Drug with Enhanced Renal Protection: A Narrative Review

Background: Topiroxostat, a selective xanthine oxidase inhibitor, effectively reduces serum urate levels in hyperuricemia patients with or without gout. The present narrative review aims to evaluate the existing evidence regarding the effectiveness of topiroxostat on renal function in patients with and without kidney disease. Materials and methods: A systematic search was conducted to identify relevant studies on renal function and topiroxostat published between 2005 and 2023. Various electronic databases were searched using different combinations of medical subject headings (MeSH) terms, and cross-referencing was performed. A total of 3146 articles were retrieved, and 18 met the inclusion and exclusion criteria. Results: The review included 18 studies investigating the effectiveness of topiroxostat on renal function in patients with and without kidney disease. Topiroxostat demonstrated maintenance of renal function, as evidenced by stable levels of estimated glomerular filtration rate (eGFR), serum creatinine, urinary albumin, and urinary protein. Furthermore, topiroxostat led to improvements in renal function, including increased eGFR and decreased levels of urinary albumin, uric acid, urinary protein, urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), and liver-type fatty acid-binding protein (L-FABP) following treatment. The literature also supports the safety profile of topiroxostat. Conclusion: Topiroxostat shows promise as an efficient and safe renoprotective agent in patients, irrespective of renal disease status. However, further large-scale, long-term, and multicenter clinical studies are needed to generate high-quality evidence in different populations and settings.