Li Ya-Jia, Chen Li-Rong, Yang Zhong-Lei, Wang Ping, Jiang Fang-Fang, Guo Yu, Qian Kai, Yang Mei, Yin Sun-Jun, He Gong-Hao
Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, 650032, Kunming, China.
Clin Rheumatol. 2023 Jan;42(1):215-224. doi: 10.1007/s10067-022-06356-z. Epub 2022 Aug 29.
The current world witnesses a greatly increased prevalence and incidence of hyperuricemia and gout with unfortunately the comparative efficacy and safety of present available uricosuric agents remaining uncertain. We herein aimed to investigate the most appropriate uricosuric agent for gout or hyperuricemia patients.
PubMed, Embase, Cochrane Library databases, and ClinicalTrials.gov from inception to 2 July 2022 were searched to retrieve eligible studies assessing efficacy and safety of uricosuric drugs in hyperuricemia or gout patients. Network meta-analysis was carried out using the Stata 16.0 software.
Twelve randomized controlled trials comprising 1851 patients were eventually included. Network meta-analysis showed that dotinurad 4 mg once daily, verinurad, dotinurad 2 mg once daily, dotinurad 1 mg once daily, and benzbromarone were the top 5 effective treatments to achieve target serum uric acid. Furthermore, dotinurad 4 mg once daily was more effective at achieving urate-lowering targets (RR of dotinurad 4 mg once daily vs. probenecid: 1.68, 95% CI [1.13; 2.50]) and safer (RR of probenecid vs. dotinurad 4 mg once daily: 1.77, 95% CI [0.69; 4.56]) than probenecid.
This network meta-analysis demonstrated an important absolute benefit of dotinurad 4 mg once daily to achieve target serum uric acid and low risk of adverse events for drug treatment of gout or hyperuricemia patients. Additionally, verinurad might be used as an alternative uricosuric therapeutic option to dotinurad. These findings provided further comprehensive insight into the treatment value of current uricosuric agents for gout or hyperuricemia. Key Points 1. This is the first systematic review and network meta-analysis examining the efficacy and safety of currently available uricosuric agents in gout or hyperuricemia patients. 2. Recommended doses of dotinurad 4mg once daily used for the treatment of gout or hyperuricemia patients can significantly decrease serum uric acid levels. 3. The present findings will provide further comprehensive insight into the treatment value of certain uricosuric agents for gout or hyperuricemia.
当前全球高尿酸血症和痛风的患病率及发病率大幅上升，遗憾的是，现有促尿酸排泄药物的相对疗效和安全性仍不明确。我们旨在研究最适合痛风或高尿酸血症患者的促尿酸排泄药物。
检索了PubMed、Embase、Cochrane图书馆数据库以及ClinicalTrials.gov从创建至2022年7月2日的数据，以获取评估促尿酸排泄药物在高尿酸血症或痛风患者中疗效和安全性的合格研究。使用Stata 16.0软件进行网状Meta分析。
最终纳入了12项随机对照试验，共1851例患者。网状Meta分析表明，每日一次服用4mg度洛西汀、维立鲁胺、每日一次服用2mg度洛西汀、每日一次服用1mg度洛西汀和苯溴马隆是实现血清尿酸目标的前5种有效治疗方法。此外，每日一次服用4mg度洛西汀在实现降尿酸目标方面更有效（每日一次服用4mg度洛西汀与丙磺舒的RR：1.68，95%CI[1.13；2.50]），且比丙磺舒更安全（丙磺舒与每日一次服用4mg度洛西汀的RR：1.77，95%CI[0.69；4.56]）。
这项网状Meta分析表明，每日一次服用4mg度洛西汀在实现血清尿酸目标方面具有重要的绝对益处，且在痛风或高尿酸血症患者的药物治疗中不良事件风险较低。此外，维立鲁胺可作为度洛西汀的替代促尿酸排泄治疗选择。这些发现为当前促尿酸排泄药物对痛风或高尿酸血症的治疗价值提供了更全面的见解。要点1.这是第一项系统评价和网状Meta分析，研究现有促尿酸排泄药物在痛风或高尿酸血症患者中的疗效和安全性。2.推荐用于治疗痛风或高尿酸血症患者的每日一次服用4mg度洛西汀剂量可显著降低血清尿酸水平。3.目前的研究结果将为某些促尿酸排泄药物对痛风或高尿酸血症的治疗价值提供更全面的见解。
