Yu-Jiun Lin1,2, Shiyng-Yu Lin1,2, Chang-Hsien Lin1,2, Sen-Te Wang1,2,3, Shy-Shin Chang4,5. 1. Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan. 2. Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei, 110, Taiwan. 3. Health Management Center, Taipei Medical University Hospital, Taipei, Taiwan. 4. Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan. sschang0529@gmail.com. 5. Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei, 110, Taiwan. sschang0529@gmail.com.
Abstract
OBJECTIVE: Hyperuricemia is a strong precursor of gout, which deteriorates patients' health and quality of life. Sustained adherence to urate-lowering therapies (ULTs) is crucial for efficacy and therapeutic cost-effectiveness. Recently, several new ULTs have been proposed. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to reassess the efficacy and safety of the current ULTs, focusing on adherence attrition-related adverse event reporting. METHOD: The Bayesian network meta-analysis was applied to compare ULTs. Drug efficacy and safety were measured by whether the target level of serum urate acid was achieved and whether any adverse events occurred. The results were summarized using the pooled estimates of effect sizes (odds ratios), their precisions (95% credible interval), and the ranking probabilities. RESULTS AND CONCLUSIONS: Thirty-nine RCTs were identified, accumulating 19,401 patients. Consistent with previous studies, febuxostat (≥ 40 mg/day) was superior to other monoagent ULTs. The new findings were as follows: (i) dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse effects when lesinurad is uptitrated is needed, and (ii) terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat ≥ 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events. Evidence from RCTs regarding second-line agents, such as probenecid and pegloticase, remains insufficient for clinical decision-making.Key Points• Dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse-effects when lesinurad is uptitrated is needed.• Terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events.
OBJECTIVE:Hyperuricemia is a strong precursor of gout, which deteriorates patients' health and quality of life. Sustained adherence to urate-lowering therapies (ULTs) is crucial for efficacy and therapeutic cost-effectiveness. Recently, several new ULTs have been proposed. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to reassess the efficacy and safety of the current ULTs, focusing on adherence attrition-related adverse event reporting. METHOD: The Bayesian network meta-analysis was applied to compare ULTs. Drug efficacy and safety were measured by whether the target level of serum urate acid was achieved and whether any adverse events occurred. The results were summarized using the pooled estimates of effect sizes (odds ratios), their precisions (95% credible interval), and the ranking probabilities. RESULTS AND CONCLUSIONS: Thirty-nine RCTs were identified, accumulating 19,401 patients. Consistent with previous studies, febuxostat (≥ 40 mg/day) was superior to other monoagent ULTs. The new findings were as follows: (i) dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse effects when lesinurad is uptitrated is needed, and (ii) terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat ≥ 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events. Evidence from RCTs regarding second-line agents, such as probenecid and pegloticase, remains insufficient for clinical decision-making.Key Points• Dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse-effects when lesinurad is uptitrated is needed.• Terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events.
Authors: Michael M Givertz; Kevin J Anstrom; Margaret M Redfield; Anita Deswal; Haissam Haddad; Javed Butler; W H Wilson Tang; Mark E Dunlap; Martin M LeWinter; Douglas L Mann; G Michael Felker; Christopher M O'Connor; Steven R Goldsmith; Elizabeth O Ofili; Mitchell T Saltzberg; Kenneth B Margulies; Thomas P Cappola; Marvin A Konstam; Marc J Semigran; Steven E McNulty; Kerry L Lee; Monica R Shah; Adrian F Hernandez Journal: Circulation Date: 2015-04-14 Impact factor: 29.690
Authors: Michael A Becker; H Ralph Schumacher; Luis R Espinoza; Alvin F Wells; Patricia MacDonald; Eric Lloyd; Christopher Lademacher Journal: Arthritis Res Ther Date: 2010-04-06 Impact factor: 5.156