Comparison of cardiovascular safety between febuxostat and allopurinol: a meta analysis
10.3760/cma.j.cn114015-20211022-01091
- VernacularTitle:非布司他与别嘌醇心血管安全性比较的meta分析
- Author:
Jianhao DENG
1
;
Jiaxing ZHANG
;
Qian ZHUANG
Author Information
1. 福建省龙岩市第二医院药学部，龙岩 364000
- Publication Type:Journal Article
- Keywords:
Cardiovascular system;
Safety;
Meta-analysis;
Febuxostat;
Allopurinol
- From:
Adverse Drug Reactions Journal
2022;24(5):239-245
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the cardiovascular safety of febuxostat and allopurinol in patients with gout/hyperuricemia, and to explore the difference in cardiovascular safety between Asian and non-Asian patients.Methods:Randomized controlled trials (RCTs) and cohort studies of comparision of cardiovascular safety between febuxostat (the trial group) and allopurinol (the control group) in the treatment of gout/hyperuricemia were collected by searching related databases at home and abroad (up to October, 2021). The outcome indicators were the incidences of acute decompensated heart failure (ADHF), stroke, acute coronary syndrome (ACS), coronary revascularization, death from cardiovascular causes, and all-cause death. The Cochrane collaboration risk of bias risk tool and Newcastle Ottawa Scale were used to evaluate the quality of the RCTs and the cohort studies, respectively. RevMan 5.4 software was used for meta-analysis, and the effect sizes were relative risk ( RR) and its 95% confidence interval ( CI). Results:A total of 9 RCTs and 7 cohort studies were enrolled in the analysis and 385 700 patients were involved, including 123 565 in the trial group and 262 135 in the control group. The results of quality evaluation showed that there were 4 and 5 RCTs with low and uncertain bias risk in 9 RCTs, respectively; among the 7 cohort studies, 2 and 5 were of high and medium quality, respectively. The result of meta-analysis of RCTs showed that the incidence of ADHF in the trial group was significantly lower than that in the control group [1.37% (77/5 620) vs. 2.21% (102/4 607), RR=0.74, 95 %CI: 0.55-0.99, P=0.04]. The result of meta-analysis of cohort studies showed that the incidence of stroke in Asian patients in the trial group was lower than that in the control group [0.87% (519/59 559) vs. 0.90% (810/89 836), RR=0.94, 95 %CI: 0.75-1.17, P=0.58]; the incidence of stroke in non-Asian patients in the trial group was lower than that in the control group, and the difference was statistically significant [1.49% (377/25 306) vs. 1.70% (1 305/76 864), RR=0.88, 95 %CI: 0.78-0.98, P=0.02]; the incidence of cardiovascular death in Asian patients in the trial group was higher than that in the control group [0.96% (473/49 373) vs. 0.68% (335/49 368), RR=1.41, 95 %CI: 1.23-1.62, P<0.01]. Conclusions:The risk of ADHF caused by febuxostat is lower than that caused by allopurinol; the risk of stroke caused by febuxostat is lower than that caused by allopurinol in non-Asian patients; the risk of cardiovascular death caused by febuxostat is higher than that caused by allopurinol in Asian patients.
