Cardiovascular safety of febuxostat versus allopurinol among the Asian patients with or without gout: A systematic review and meta-analysis.
Jian-Hao DengPeng-Hui LaiLi-Shan XieShu-Sheng QiuDe-Sheng QiuJia-Xing ZhangPublished in: Clinical and translational science (2024)
The cardiovascular (CV) safety of febuxostat compared to allopurinol for the treatment of hyperuricemia among Asian patients is uncertain. In this study, we conducted a systematic review and meta-analysis to compare the CV safety profiles of febuxostat with allopurinol in Asian patients with hyperuricemia. A total of 13 studies were included. On the basis of the pooled results of cohort studies, febuxostat users were at a significantly higher risk for acute coronary syndrome (ACS; hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.03-1.09, p < 0.01), atrial fibrillation (HR: 1.19, 95% CI: 1.05-1.35, p < 0.01) than allopurinol users, whereas no significant difference between febuxostat and allopurinol existed for urgent coronary revascularization (HR: 1.07, 95% CI: 0.98-1.16, p = 0.13), and stroke (HR: 0.96, 95% CI: 0.91-1.01, p = 0.13). Nevertheless, that difference in results of acute decompensated heart failure (ADHF; HR: 0.73, 95% CI: 0.35-1.53, p = 0.40) and all-cause death (HR = 0.86, 95% CI: 0.49-1.51, p = 0.60) was not significant based on randomized controlled trials. In the Chinese subgroup, febuxostat could increase the risk of ADHF (HR: 1.22, 95% CI: 1.01-1.48, p < 0.05), CV death (HR: 1.25, 95% CI: 1.03-1.50, p < 0.05), and all-cause mortality (HR: 1.07, 95% CI: 1.01-1.14, p < 0.05) compared to allopurinol. In conclusion, the use of febuxostat, compared with allopurinol among Asian patients, was associated with a significantly increased risk of adverse CV events.
Keyphrases
- heart failure
- atrial fibrillation
- acute coronary syndrome
- end stage renal disease
- ejection fraction
- chronic kidney disease
- newly diagnosed
- randomized controlled trial
- peritoneal dialysis
- uric acid
- coronary artery disease
- clinical trial
- liver failure
- left ventricular
- emergency department
- coronary artery
- metabolic syndrome
- systematic review
- left atrial
- patient reported outcomes
- adverse drug
- catheter ablation
- electronic health record
- antiplatelet therapy
- smoking cessation
- transcatheter aortic valve replacement
- cerebral ischemia
- open label
- replacement therapy
- left atrial appendage
- blood brain barrier