• Yu-Yu Tien, Ming-Chieh Shih, Chiao-Pang Tien, Huei-Kai Huang, and Yu-Kang Tu.
• From the Department of Family Medicine, Hsinchu Cathay General Hospital, Hsinchu, Taiwan (YYT); Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (YYT, MCS, HKH, YKT); Department of Nephrology, Taipei City Hospital, Renai Branch, Taipei, Taiwan (CPT); Department of Family Medicine, Hualian Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (HKH); Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan (YYT); Department of Dentistry, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan (YKT).
• J Am Board Fam Med. 2022 Jan 1; 35 (1): 140-151.

PurposeHyperuricemia is associated with increased cardiovascular risk. Because patients with asymptomatic hyperuricemia (AH) experience no immediate discomfort and there are possible side effects of urate-lowering drugs, treatment for AH is controversial. We aimed to perform a network meta-analysis (NMA) to investigate the effects of different urate-lowering therapies (ULTs) on serum uric acid level, renal function, blood pressure (BP), and safety in AH patients.MethodsThis NMA focused on AH patients. The intervention group (patients receiving urate-lowering drugs) was compared with others using other types of drugs, placebo, or usual care. We undertook a NMA under the frequentist framework by R.ResultsThirteen eligible trials were identified. The interventions included allopurinol, febuxostat, and benzbromarone, which are not approved in the United States. Benzbromarone and allopurinol had the best efficacy on lowering serum uric acid level in short-term and long-term follow-up (mean difference [MD] = -3.05; 95% CI, -5.19 to -0.91 vs MD = -3.17; 95% CI, -5.19 to -1.15). Patients using allopurinol had significantly higher eGFR than using placebo in both short-term and long-term follow-up (MD = 3.07; 95% CI, 0.18 to 5.95 vs MD = 4.10; 95% CI, 2.66 to 5.54). No difference in BP was found between groups, except for febuxostat to diastolic BP after long-term treatment (MD = -1.47; 95% CI, -2.91 to -0.04). No statistically increased odds of safety events were found with the use of ULT.ConclusionsOur result showed that in AH patients, allopurinol has a renoprotective effect. Febuxostat has a significant impact in lowering diastolic BP. ULT does not result in a higher risk of safety events.© Copyright 2022 by the American Board of Family Medicine.

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