title: Cardiovascular effects of urate-lowering therapies in patients with chronic gout: a systematic review and meta-analysis.
abstract: To determine if urate-lowering treatment (ULT) in gout can reduce cardiovascular (CV) outcomes.
  
  
  
  Randomized trials were searched for treatment with ULT in gout. Eligible trials had to report CV safety of a ULT. Potential medications included allopurinol, febuxostat, pegloticase, rasburicase, probenecid, benzbromarone, sulphinpyrazone, losartan, fenofibrate and sodium-glucose linked transporter 2 inhibitors.
  
  
  
  A total of 3084 citations were found, with 642 duplicates. After the primary screen, 35 studies were selected for review. Several trials did not report CV events. Six were not randomized controlled trials (RCTs). Four studies reported no events in either intervention arm while the other four had 40 events in the febuxostat group ( n = 3631) and 5 in allopurinol group ( n = 1154). Overall, the pooled analysis did not show a significant difference between the two [febuxostat vs allopurinol: relative risk (RR) 1.69 (95% CI 0.54, 5.34), P = 0.37]. CV events did not decrease over time. Comparing shorter studies (<52 weeks) to longer ones did not reveal any statistical differences. However, in long-term studies with febuxostat vs allopurinol, results were nearly significant, with more CVE occurring with febuxostat treatment. Comparing any ULT to placebo (eight studies, n = 2221 patients) did not demonstrate a significant difference in non-Anti-Platelet Trialists' Collaboration events [any ULT vs placebo: RR 1.47 (95% CI 0.49, 4.40), P = 0.49] or all-cause mortality [any ULT vs placebo: RR 1.45 (95% CI 0.35, 5.77), P = 0.60].
  
  
  
  RCT data do not suggest differences in CV events among ULTs in gout. Trials had few events despite high-risk patients being enrolled and may have been too short to show CV reduction by controlling inflammatory attacks and lowering uric acid.
authors.affiliation: Department of Rheumatology, Schulich School of Medicine & Dentistry, Western University of Canada, St Joseph Health Care, London, ON Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Rheumatology, Schulich School of Medicine & Dentistry, Western University of Canada, St Joseph Health Care, London, ON Canada.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
mesh_terms: D000328:Adult; D000493:Allopurinol / Q000627:therapeutic use; D015210:Arthritis, Gouty / Q000175:diagnosis / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002908:Chronic Disease; D000069465:Febuxostat / Q000627:therapeutic use; D005260:Female; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014503:Urate Oxidase / Q000627:therapeutic use
chemical_list: D006074:Gout Suppressants; D000069465:Febuxostat; D011092:Polyethylene Glycols; D000493:Allopurinol; D014503:Urate Oxidase; C031545:Pegloticase
keywords: adverse events; allopurinol; cardiovascular events; febuxostat; gout; meta-analysis; myocardial infarction; randomized controlled trials; risk reduction; uricosuric drugs