Yu-Yu Tien, MD, MS; Ming-Chieh Shih, MD, PhD; Chiao-Pang Tien, MD; Huei-Kai Huang, MD; Yu-Kang Tu, DDS, PhD
Corresponding Author: Yu-Kang Tu, DDS, PhD; Institute of Epidemiology & Preventive Medicine - College of Public Health - National Taiwan University . Email: yukangtu@ntu.edu.tw
Section: Original Research
Publication Date: 1/13/2022
Purpose: Hyperuricemia is associated with increased cardiovascular risk. Since patients with asymptomatic hyperuricemia (AH) experience no immediate discomfort and there are possible side effects of urate lowering drugs, treatment for AH is controversial. We aimed to perform a network meta-analysis (NMA) to investigate the effects of different urate lowering therapies (ULTs) on serum uric acid level, renal function, blood pressure (BP) and safety in AH patients. Methods: This NMA focused on AH patients. The intervention group was patients receiving urate lowering drug and was compared to others using other types of drug, placebo or usual care. We undertook a NMA under the frequentist framework by R. Results: Thirteen eligible trials were identified. The interventions included allopurinol, febuxostat, and benzbromarone which is not approved in the United States. Benzbromarone and allopurinol had the best efficacy on lowering serum uric acid level in short-term and long-term follow-up (MD= -3.05, 95% CI -5.19~ -0.91, MD= -3.17, 95% CI -5.19~ -1.15). Patients using allopurinol had significantly higher eGFR than using placebo in both short-term and long-term follow-up (MD= 3.07, 95% CI Abstract 0.18~5.95, MD= 4.10, 95% CI 2.66~5.54). No difference in BP was found between groups, except for febuxostat to diastolic BP after long-term treatment (MD= -1.47, 95% CI -2.91~-0.04). No statistically increased odds of safety events were found with the use of ULT. Conclusions: Our result showed that in AH patients, allopurinol has renoprotective effect. Febuxostat has significant effect on lowering diastolic BP. ULT does not result in higher risk of safety events.