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      Comparative effectiveness of allopurinol, febuxostat and benzbromarone on renal function in chronic kidney disease patients with hyperuricemia: a 13-year inception cohort study

      Author(s): 1 , 1 , 2 , 3 , 2 , 2 , 1 , 2 , 3 , CMUH Kidney Research Group
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      Journal: Nephrology Dialysis Transplantation
      Publisher: Oxford University Press (OUP)

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          Abstract

          Direct comparisons of the effectiveness of allopurinol with that of other urate-lowering agents in chronic kidney disease (CKD) populations, as well as guideline recommendations for clinical practice, are lacking.

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          Clinical practice. Gout.

          Tuhina Neogi (2011)
          Article 0 comments Cited 137 times – based on 0 reviews     Review now
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            Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel.

            Sima Halevy, Pierre-Dominique Ghislain, Maja Mockenhaupt … (2008)
            Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous adverse reactions. We sought to update knowledge on the causes of SJS or TEN with a focus on the rate of allopurinol-associated cases and to identify risk factors for allopurinol-associated SJS or TEN. We conducted a multinational case-control study. In all, 379 patients with severe cutaneous adverse reactions validated as SJS or TEN and 1505 matched hospitalized control subjects were enrolled. Allopurinol was the drug most frequently associated with SJS or TEN, with 66 exposed patients (17.4%) and 28 exposed control subjects (1.9%) (adjusted odds ratio = 18, 95% confidence interval: 11-32). Allopurinol use was greater than in a previous case-control European study. Daily doses equal to or greater than 200 mg were associated with a higher risk (adjusted odds ratio = 36, 95% confidence interval: 17-76) than lower doses (adjusted odds ratio = 3.0, 95% confidence interval: 1.1-8.4). The risk was restricted to short-term use (
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              Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis.

              Alan Cass, Sunil V Badve, Gopala Rangan … (2014)
              Non-randomized studies suggest an association between serum uric acid levels and progression of chronic kidney disease (CKD). The aim of this systematic review is to summarize evidence from randomized controlled trials (RCTs) concerning the benefits and risks of uric acid-lowering therapy on renal outcomes. Medline, Excerpta Medical Database and Cochrane Central Register of Controlled Trials were searched with English language restriction for RCTs comparing the effect of uric acid-lowering therapy with placebo/no treatment on renal outcomes. Treatment effects were summarized using random-effects meta-analysis. Eight trials (476 participants) evaluating allopurinol treatment were eligible for inclusion. There was substantial heterogeneity in baseline kidney function, cause of CKD and duration of follow-up across these studies. In five trials, there was no significant difference in change in glomerular filtration rate from baseline between the allopurinol and control arms [mean difference (MD) 3.1 mL/min/1.73 m2, 95% confidence intervals (CI) -0.9, 7.1; heterogeneity χ2=1.9, I2=0%, P=0.75]. In three trials, allopurinol treatment abrogated increases in serum creatinine from baseline (MD -0.4 mg/dL, 95% CI -0.8, -0.0 mg/dL; heterogeneity χ2=3, I2=34%, P=0.22). Allopurinol had no effect on proteinuria and blood pressure. Data for effects of allopurinol therapy on progression to end-stage kidney disease and death were scant. Allopurinol had uncertain effects on the risks of adverse events. Uric acid-lowering therapy with allopurinol may retard the progression of CKD. However, adequately powered randomized trials are required to evaluate the benefits and risks of uric acid-lowering therapy in CKD.
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                Author and article information

                Journal
                Title: Nephrology Dialysis Transplantation
                Publisher: Oxford University Press (OUP)
                ISSN (Print): 0931-0509
                ISSN (Electronic): 1460-2385
                Publication date Created: November 17 2017
                Publication date (Electronic): November 17 2017
                Affiliations
                [1 ] Clinical Research Outcome and Training Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
                [2 ] Department of Internal Medicine, Kidney Institute and Division of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
                [3 ] Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
                Article
                DOI: 10.1093/ndt/gfx313
                PubMed ID: 29165620
                SO-VID: 4e937c29-f647-4e94-8c8e-76abbed8625f
                Copyright © © 2017
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