An evidence-based review on urate-lowering treatments: implications for optimal treatment of chronic hyperuricemia

Figures & data

Figure 1 Results from pairwise meta-analysis on the size effect of urate-lowering therapy with major drugs.

Note: Adapted from Clin Ther, 2013;35, Ye P, Yang S, Zhang W, et al, Efficacy and tolerability of febuxostat in hyperuricemic patients with or without gout: a systematic review and meta-analysis, Copyright (2013), with permission from Elsevier.¹⁹
Abbreviations: A, allopurinol (100–300 mg/day); F80, febuxostat 80 mg/day; B, benzbromarone (100–200 mg/day); F120, Febuxostat 120 mg/day; F240, Febuxostat 240 mg/day.

Table 1 Main approved drugs to treat hyperuricemia

Drug	Mechanism
Allopurinol	XO inhibitor
Oxypurinol	XO inhibitor
Febuxostat	XO inhibitor
Probenecid	URAT1 inhibitor
Benzbromarone	URAT1 inhibitor
Recent new drugs	Mechanism
DHNB	XO inhibitor
Lesinurad	URAT1 inhibitor
Pegloticase	PEGylated uricase
Pegadricase	PEGylated uricase

Abbreviations: DHNB, 3,4-dihydroxy-5-nitrobenzaldehyde; PEG, polyethylene glycol.

Table 2 Key recommendations for the management of hyperuricemia

A careful management of chronic hyperuricemia
• Correct education of patients to improve adherence and optimize the results
• Modifiable risk factors:
• Obesity (Weight loss and restriction of dietary purines)
• Reduce/abolish beer, sodas, spirits, and fructose-rich beverages consumption
• Increase the intake of vitamin c
• Reduce or stop Loop and thiazide diuretics therapy
• SUA levels should be under the target value of 7 mg/dL
• Assess the global cardiovascular risk of patients with elevated SUA levels
• Urate lowering therapies with XO inhibitors should be prescribed as soon as the diagnosis is made

Abbreviation: SUA, serum uric acid.

YePYangSZhangWEfficacy and tolerability of febuxostat in hyperuricemic patients with or without gout: a systematic review and meta-analysisClin Ther20133518018923332451

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