Network Meta-Analysis of Drug Therapies for Lowering Uric Acid and Mortality Risk in Patients with Heart Failure

• Published in: Cardiovascular drugs and therapy Vol. 35; no. 6; pp. 1217 - 1225
• Main Authors: Kodama, Satoru, Fujihara, Kazuya, Horikawa, Chika, Yamada, Mayuko, Sato, Takaaki, Yaguchi, Yuta, Yamamoto, Masahiko, Kitazawa, Masaru, Matsubayashi, Yasuhiro, Yamada, Takaho, Watanabe, Kenichi, Sone, Hirohito
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2021; Springer Nature B.V
• Subjects: Allopurinol; Allopurinol - administration & dosage; Allopurinol - therapeutic use; Cardiology; Clinical trials; Confidence intervals; Congestive heart failure; Drugs; Gout Suppressants - administration & dosage; Gout Suppressants - therapeutic use; Heart failure; Heart Failure - epidemiology; Heart Failure - mortality; Humans; Hyperuricemia; Hyperuricemia - drug therapy; Hyperuricemia - epidemiology; Literature reviews; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Network Meta-Analysis; Original Article; Patients; Risk; Uric acid; Uric Acid - blood; Heart failure; Network meta-analysis; Hyperuricemia; Uric acid
• ISSN: 0920-3206; 1573-7241
• DOI: 10.1007/s10557-020-07097-4

Purpose This network meta-analysis aimed to assess the current efficacy of decreasing the uric acid (UA) level with drugs to reduce mortality in patients with heart failure (HF). Methods Electronic literature searches using EMBASE and MEDLINE of studies published from 1 Jan 1950 to 26 Dec 2019 were conducted for randomized controlled trials or non-randomized cohort studies that included at least one group of patients who took UA-lowering drugs and with a study outcome of all-cause mortality. A random-effects network meta-analysis was performed within a frequentist framework. Hierarchy of treatments was expressed as the surface under the cumulative ranking curve (SUCRA) value, which is in proportion to mean rank (best is 100%). Results Nine studies, which included seven different types of groups, were eligible for analysis. The “untreated uricemia” group in which patients had hyperuricemia but without treatment had a significantly higher risk of mortality than the “no uricemia” group in which patients had no hyperuricemia (relative risk (RR)(95% confidence interval (CI), 1.43 (1.08–1.89)). The “start-allo” group wherein patients started to take allopurinol did not have a significantly lower risk of mortality than the “untreated uricemia” group (RR (95% CI), 0.68 (0.45–1.01)). However, in the “start-allo” group the SUCRA value was comparable to that in the “no uricemia” group (SUCRA: 65.4% for “start-allo”; 64.1% for “no uricemia”). Conclusions Results suggested that allopurinol therapy was not associated with a significantly improved prognosis in terms of mortality but could potentially counteract the adverse effects associated with longstanding hyperuricemia in HF patients.