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Comparative efficacy and safety of urate-lowering therapy for the treatment of hyperuricemia: a systematic review and network meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Network meta-analysis for indirect treatment comparisons.The network geometry is composed of nodes and edges. The size of nodes and the thickness of edges were weighted by the sample size and number of trials, respectively. A lack of lines indicates that there were no head-to-head trials between two treatments. ALLO = allopurinol, FEBU1 = febuxostat 20 mg/day, FEBU2 = febuxostat 40 mg/day, FEBU3 = febuxostat 60 mg/day, FEBU4 = febuxostat 80 mg/day, FEBU5 = febuxostat 120 mg/day, FEBU6 = febuxostat 240 mg/day, BENZ = benzbromarone, PROB = probenecid, PEGL1 = pegloticase 8 mg every 2 weeks, PEGL2 = pegloticase 8 mg every 4 weeks, PLA = placebo.
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f2: Network meta-analysis for indirect treatment comparisons.The network geometry is composed of nodes and edges. The size of nodes and the thickness of edges were weighted by the sample size and number of trials, respectively. A lack of lines indicates that there were no head-to-head trials between two treatments. ALLO = allopurinol, FEBU1 = febuxostat 20 mg/day, FEBU2 = febuxostat 40 mg/day, FEBU3 = febuxostat 60 mg/day, FEBU4 = febuxostat 80 mg/day, FEBU5 = febuxostat 120 mg/day, FEBU6 = febuxostat 240 mg/day, BENZ = benzbromarone, PROB = probenecid, PEGL1 = pegloticase 8 mg every 2 weeks, PEGL2 = pegloticase 8 mg every 4 weeks, PLA = placebo.

Mentions: A network graphical structure displays the available direct comparisons of the network of trials organized from the fourteen RCTs (Fig. 2). Comparisons with febuxostat (20/40/60/80/120/240 mg once daily) or pegloticase (8 mg every two/four weeks) were classified by dosage.


Comparative efficacy and safety of urate-lowering therapy for the treatment of hyperuricemia: a systematic review and network meta-analysis
Network meta-analysis for indirect treatment comparisons.The network geometry is composed of nodes and edges. The size of nodes and the thickness of edges were weighted by the sample size and number of trials, respectively. A lack of lines indicates that there were no head-to-head trials between two treatments. ALLO = allopurinol, FEBU1 = febuxostat 20 mg/day, FEBU2 = febuxostat 40 mg/day, FEBU3 = febuxostat 60 mg/day, FEBU4 = febuxostat 80 mg/day, FEBU5 = febuxostat 120 mg/day, FEBU6 = febuxostat 240 mg/day, BENZ = benzbromarone, PROB = probenecid, PEGL1 = pegloticase 8 mg every 2 weeks, PEGL2 = pegloticase 8 mg every 4 weeks, PLA = placebo.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015109&req=5

f2: Network meta-analysis for indirect treatment comparisons.The network geometry is composed of nodes and edges. The size of nodes and the thickness of edges were weighted by the sample size and number of trials, respectively. A lack of lines indicates that there were no head-to-head trials between two treatments. ALLO = allopurinol, FEBU1 = febuxostat 20 mg/day, FEBU2 = febuxostat 40 mg/day, FEBU3 = febuxostat 60 mg/day, FEBU4 = febuxostat 80 mg/day, FEBU5 = febuxostat 120 mg/day, FEBU6 = febuxostat 240 mg/day, BENZ = benzbromarone, PROB = probenecid, PEGL1 = pegloticase 8 mg every 2 weeks, PEGL2 = pegloticase 8 mg every 4 weeks, PLA = placebo.
Mentions: A network graphical structure displays the available direct comparisons of the network of trials organized from the fourteen RCTs (Fig. 2). Comparisons with febuxostat (20/40/60/80/120/240 mg once daily) or pegloticase (8 mg every two/four weeks) were classified by dosage.

View Article: PubMed Central - PubMed

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus