Comparative efficacy and safety of urate-lowering therapy for the treatment of hyperuricemia: a systematic review and network meta-analysis.
The prevalence of hyperuricemia and gout has been increasing, but the comparative effectiveness and safety of different treatments remain uncertain. We aimed to compare the effectiveness and safety of different treatments for hyperuricemia using network meta-analysis methodology. We systematically reviewed fifteen randomized controlled trials (involving 7,246 patients through January 2016) that compared the effects of different urate-lowering drugs (allopurinol, benzbromarone, febuxostat, pegloticase and probenecid) on hyperuricemia. Drug efficacy and safety, as outcomes, were measured by whether the target level of serum urate acid was achieved and whether any adverse events occurred, respectively. We derived pooled effect sizes expressed as odds ratios (ORs) and 95% confidence intervals (CIs). The efficacy and safety of the drugs were ranked by cumulative ranking probabilities. Our findings show that febuxostat, benzbromarone, probenecid, pegloticase, and allopurinol were all highly effective at reducing the risk of hyperuricemia compared to placebo. Febuxostat had the best efficacy and safety compared to the other drugs. Furthermore, febuxostat 120 mg QD was more effective at achieving urate-lowering targets (OR: 0.17, 95% CI: 0.12-0.24) and safer (OR: 0.72, 95% CI: 0.56-0.91) than allopurinol.
Department of Health Service &Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.|Metabolic Disease Hospital &Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China.
Shu
S
Li
Department of Health Service &Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.|Metabolic Disease Hospital &Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China.
Hongxi
H
Yang
Department of Health Service &Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
Yanan
Y
Guo
Research Center of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
Fengjiang
F
Wei
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
Xilin
X
Yang
Metabolic Disease Hospital &Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China.
Daiqing
D
Li
Metabolic Disease Hospital &Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300070, China.
Mingzhen
M
Li
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.|Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Weili
W
Xu
Research Center of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
Weidong
W
Li
Department of Health Service &Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
Li
L
Sun
Department of Health Service &Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
Ying
Y
Gao
Department of Health Service &Care Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
Yaogang
Y
Wang
D006073:Gout / Q000097:blood / Q000188:drug therapy; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000097:blood* / Q000188:drug therapy*; D016017:Odds Ratio; D011336:Probability; D016032:Randomized Controlled Trials as Topic; D014527:Uric Acid / Q000097:blood*
D006074:Gout Suppressants; D014527:Uric Acid