Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan.
Nutr Metab Cardiovasc Dis. 2019 Oct;29(10):1011-1022. doi: 10.1016/j.numecd.2019.06.016. Epub 2019 Jun 24.
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.
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.
Febuxostat vs. allopurinol was associated with the improved safety outcome and have comparable mortality and net clinical outcome in patients with hyperuricemia.
PROSPERO(CRD42018091657).
系统评价和荟萃分析表明，高尿酸血症是心血管疾病的一个危险因素。黄嘌呤氧化酶抑制剂对心脏结局的影响尚不清楚。我们评估了别嘌醇和非布司他对高尿酸血症成年患者死亡率和不良反应的影响。
从 2005 年 1 月至 2018 年 7 月，我们在 PubMed 和 EMBASE 上检索了关于别嘌醇和非布司他的随机对照试验。该荟萃分析共纳入了 13 项随机对照试验，共 13539 例患者。非布司他与别嘌醇相比，总体人群中心血管相关死亡率无增加风险（OR：0.72，95%CI：0.24-2.13，P=0.55）。关于皮肤不良反应，接受非布司他治疗的患者皮肤不良反应发生率明显低于接受别嘌醇治疗的患者（OR：0.50，95%CI：0.30-0.85，P=0.01）。与别嘌醇相比，非布司他在心血管相关死亡率和皮肤不良反应方面的安全性更好（OR：0.72，95%CI：0.55-0.96，P=0.02）。接受非布司他或别嘌醇治疗的患者，复合终点（痛风发作和安全性结局）无显著差异（OR：1.04，95%CI：0.76-1.42，P=0.79）。在敏感性分析中，纳入 CARES 研究后，接受非布司他治疗的患者与接受别嘌醇治疗的患者相比，心血管相关死亡率有边缘显著意义（OR：1.29，95%CI：1.00-1.67，P=0.05）。
与别嘌醇相比，非布司他在改善安全性结局方面具有优势，且在高尿酸血症患者中死亡率和净临床结局相当。
PROSPERO（CRD42018091657）。
