Advances in pharmacotherapies for hyperuricemia

ABSTRACT

Introduction

Hyperuricemia is an overlooked cardiovascular and renal risk factor. Epidemiological and genetic studies have shown an independent role of uric acid in the risk of coronary artery disease, heart failure, chronic kidney disease, and cardiovascular mortality. Treatment options include xanthine oxidase inhibitors, uricosuric medications, and the recombinant uricases. Whether to treat asymptomatic hyperuricemia, and to which target, remains debated. However, the results of recent trials and meta-analysis seem to support this therapeutic strategy.

Areas covered

In the present review, we summarized current therapeutic indications and options for the treatment of symptomatic and asymptomatic hyperuricemia. Furthermore, we searched the recent literature (last 5 years: 2018 to 2022) to report the results of randomized controlled trials and meta-analysis on cardiovascular and nephroprotective effects of hypouricemic agents.

Expert opinion

Future large well-designed clinical trials on the role of hypouricemic agents in nephroprotection and cardiovascular prevention and treatment are warranted and may extend their indications and use, with a direct impact on morbidity and mortality. Differentiating between hyperproducing and hypoexcreting phenotypes may help designing future trials improving the consistency of results. Finally, medications with cardio and nephroprotective properties have shown to reduce serum uric acid levels and may be used in patients with hyperuricemia and other cardiovascular complications.

KEYWORDS:

• Hyperuricemia
• cardiovascular risk
• hypouricemic agents
• urate lowering
• xanthine oxidase inhibitors
• uricosurics
• recombinant uricase
• allopurinol

Article highlights

• Whether to treat asymptomatic hyperuricemia remains debated, in the present paper we provide our expert opinion on the topic

• Whether to treat asymptomatic hyperuricemia remains debated, in the present paper we provide our expert opinion on the topic

• We searched the literature for recent studies on cardioprotective and nephroprotective properties of hypouricemic agents

• In the present study, we also present cardiovascular medications effective in reducing serum uric acid levels

Declaration of interest

C Borghi reports serving as a lecturer for Servier, Menarini, Alfasigma, Sanofi, Novo Nordisk, Egis, Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The paper was not funded.