Journal ArticleDOI
The net clinical benefits of febuxostat versus allopurinol in patients with gout or asymptomatic hyperuricemia - A systematic review and meta-analysis.
Cheng-Wei Liu,Wei-Cheng Chang,Chiao-Chin Lee,Wen-Yi Shau,Fu-Shun Hsu,Man-Ling Wang,Tsung-Chih Chen,Chiao Lo,Juey-Jen Hwang +8 more
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TLDR
Febuxostat vs. allopurinol was associated with the improved safety outcome and have comparable mortality and net clinical outcome in patients with hyperuricemia.Abstract:
Background and aims Systemic reviews and meta-analyses suggest hyperuricemia is a cardiovascular risk factor. The effects of xanthine oxidase inhibitors on cardiac outcomes remain unclear. We assessed the effects of febuxostat and allopurinol on mortality and adverse reactions in adult patients with hyperuricemia. Methods and results PubMed and EMBASE were searched to retrieve randomized controlled trials of febuxostat and allopurinol from January 2005 to July 2018. The meta-analysis consisted of 13 randomized controlled trials with a combined sample size of 13,539 patients. Febuxostat vs. allopurinol was not associated with an increased risk of cardiac-related mortality in the overall population (OR: 0.72, 95% CI: 0.24–2.13, P = 0.55). Regarding adverse skin reactions, the patients receiving febuxostat had significantly fewer adverse skin reactions than those receiving allopurinol treatment (OR: 0.50, 95% CI: 0.30–085, P = 0.01). Compared with allopurinol, febuxostat was associated with an improved safety outcome of cardiac-related mortality and adverse skin reactions (OR: 0.72, 95% CI: 0.55–0.96, P = 0.02). The net clinical outcome, composite of incident gout and the safety outcome, was not different significantly in the patients receiving febuxostat or allopurinol (OR: 1.04, 95% CI: 0.76–0.1.42, P = 0.79). In sensitivity analyses, a borderline significance was found in the patients randomized to febuxostat vs. allopurinol regarding cardiac-related mortality (OR: 1.29, 95% CI: 1.00–1.67, P = 0.05) after the CARES study was included. Conclusion Febuxostat vs. allopurinol was associated with the improved safety outcome and have comparable mortality and net clinical outcome in patients with hyperuricemia. Registration number PROSPERO(CRD42018091657).read more
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Journal ArticleDOI
Clinical Effects of Xanthine Oxidase Inhibitors in Hyperuricemic Patients.
TL;DR: Large long-term clinical trials have demonstrated that xanthine oxidase inhibitors (XOIs, namely, allopurinol and febuxostat) are effective, safe, and relatively well-tolerated in most of the patients.
Journal ArticleDOI
Therapeutic Strategies for the Treatment of Chronic Hyperuricemia: An Evidence-Based Update
TL;DR: In this article, the authors reviewed the evidence on the available therapeutic strategies for the treatment of hyperuricemia and found that Xanthine oxidase inhibitors are the safest and most effective uric acid lowering drugs for the management of chronic hyperURICemia, while the efficacy of uricosuric agents is strongly modulated by pharmacogenetics.
Journal ArticleDOI
Management of hyperuricemia in asymptomatic patients: A critical appraisal
TL;DR: RCTs with hard end-points are needed to assess the risk/benefit of lowering uric acid in subjects with AH, particularly as secondary prevention for cardiovascular risk and in patients with different degrees of renal disease.
Journal ArticleDOI
Molecular Dockings and Molecular Dynamics Simulations Reveal the Potency of Different Inhibitors against Xanthine Oxidase.
TL;DR: Simulation results showed the similarities and differences of the interaction between the three inhibitors binding to the protein and suggested that, among three inhibitors, allopurinol had the best binding effect with XO followed by daidzin and puerarin.
Journal ArticleDOI
Cardiovascular safety of febuxostat compared to allopurinol for the treatment of gout: A systematic and meta-analysis.
TL;DR: In this article, a systematic review and meta-analysis of included clinical trials to evaluate the cardiovascular safety of febuxostat compared to allopurinol for treatment of chronic gout was conducted.
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