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Clinical Rheumatology

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21.01.2020 | Original Article

Evaluation of urate-lowering therapy in hyperuricemia patients: a systematic review and Bayesian network meta-analysis of randomized controlled trials

verfasst von: Yu-Jiun Lin, Shiyng-Yu Lin, Chang-Hsien Lin, Sen-Te Wang, Shy-Shin Chang

Erschienen in: Clinical Rheumatology | Ausgabe 5/2020

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Abstract

Objective

Hyperuricemia is a strong precursor of gout, which deteriorates patients’ health and quality of life. Sustained adherence to urate-lowering therapies (ULTs) is crucial for efficacy and therapeutic cost-effectiveness. Recently, several new ULTs have been proposed. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to reassess the efficacy and safety of the current ULTs, focusing on adherence attrition-related adverse event reporting.

Method

The Bayesian network meta-analysis was applied to compare ULTs. Drug efficacy and safety were measured by whether the target level of serum urate acid was achieved and whether any adverse events occurred. The results were summarized using the pooled estimates of effect sizes (odds ratios), their precisions (95% credible interval), and the ranking probabilities.

Results and Conclusions

Thirty-nine RCTs were identified, accumulating 19,401 patients. Consistent with previous studies, febuxostat (≥ 40 mg/day) was superior to other monoagent ULTs. The new findings were as follows: (i) dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse effects when lesinurad is uptitrated is needed, and (ii) terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat ≥ 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events. Evidence from RCTs regarding second-line agents, such as probenecid and pegloticase, remains insufficient for clinical decision-making.

Key Points

• Dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse-effects when lesinurad is uptitrated is needed.

• Terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events.

Nur mit Berechtigung zugänglich

Richette P et al (2017) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 76(1):29–42PubMed

Khanna D et al (2012) American college of rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res 64(10):1431–1446

Hui M, Carr A, Cameron S, Davenport G, Doherty M, Forrester H, Jenkins W, Jordan KM, Mallen CD, McDonald T, Nuki G, Pywell A, Zhang W, Roddy E, British Society for Rheumatology Standards, Audit and Guidelines Working Group (2017) The British Society for Rheumatology guideline for the management of gout. Rheumatology 56(7):e1–e20PubMed

Yu KH, Chen DY, Chen JH, Chen SY, Chen SM, Cheng TT et al (2018) Management of gout and hyperuricemia: Multidisciplinary consensus in Taiwan. Int J Rheum Dis. 21(4):772–787PubMed

Shekelle PG, Newberry SJ, FitzGerald J, Motala A, O'Hanlon CE, Tariq A, Okunogbe A, Han D, Shanman R (2017) Management of gout: a systematic review in support of an American college of physicians clinical practice guideline. Ann Intern Med 166(1):37–51PubMed

Ashiq K et al (2018) A systematic review on the prevalence, pathophysiology, diagnosis, management and treatment of gout (2007-2018). GSC Biol Pharm Sci 5(1):050–055

Ahmed S et al (2018) Pathophysiology, clinical consequences, epidemiology and treatment of hyperurecemic gout. RADS J Pharm Pharm Sci 6(1):88–93

Stamp L, Morillon MB, Taylor WJ, Dalbeth N, Singh JA, Lassere M et al (2018) Serum urate as surrogate endpoint for flares in people with gout: A systematic review and meta-regression analysis. Semin Arthritis Rheum. 48(2):293–301PubMed

Luo Q, Xia X, Li B, Lin Z, Yu X, Huang F (2019) Serum uric acid and cardiovascular mortality in chronic kidney disease: a meta-analysis. BMC Nephrol. 20(1):18PubMedCentralPubMed

10.

Liu J, Tao L, Zhao Z, Mu Y, Zou D, Zhang J et al (2018) Two-Year Changes in Hyperuricemia and Risk of Diabetes: A Five-Year Prospective Cohort Study. J Diabetes Res. 2018:6905720PubMedCentralPubMed

11.

Zheng X, Gong L, Luo R, Chen H, Peng B, Ren W et al (2017) Serum uric acid and non-alcoholic fatty liver disease in non-obesity Chinese adults. Lipids Health Dis. 16(1):202PubMedCentralPubMed

12.

Zhou F et al (2019) Association of serum uric acid levels with the incident of kidney disease and rapid eGFR decline in Chinese individuals with eGFR > 60 mL/min/1.73 m2 and negative proteinuria. Clin Exp Nephrol 23(7):871–879PubMed

13.

Fu T et al (2018) Depression and anxiety correlate with disease-related characteristics and quality of life in Chinese patients with gout: a case-control study. Psychol Health Med 23(4):400–410PubMed

14.

Kiadaliri AA, Englund M, Uhlig T (2018) Burden of gout in the Nordic region, 1990–2015: findings from the Global Burden of Disease Study 2015. Scand J Rheumatol 47(5):410–417PubMed

15.

Song P, Wang H, Xia W, Chang X, Wang M, An L (2018) Prevalence and correlates of hyperuricemia in the middle-aged and older adults in China. Sci Rep. 8(1):4314PubMedCentralPubMed

16.

Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M (2015) Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 74(4):661–667PubMed

17.

McGowan B, Bennett K, Silke C, Whelan B (2016) Adherence and persistence to urate-lowering therapies in the Irish setting. Clin Rheumatol. 35(3):715–721PubMed

18.

Janssen CA, Oude Voshaar MAH, Vonkeman HE, Krol M, van de Laar M (2018) A retrospective analysis of medication prescription records for determining the levels of compliance and persistence to urate-lowering therapy for the treatment of gout and hyperuricemia in The Netherlands. Clin Rheumatol. 37(8):2291–2296PubMedCentralPubMed

19.

Yamanaka H, Togashi R, Hakoda M, Terai C, Kashiwazaki S, Dan T, Kamatani N (1998) Optimal range of serum urate concentrations to minimize risk of gouty attacks during anti-hyperuricemic treatment. Adv Exp Med Biol 431:13–18PubMed

20.

Beslon V, Moreau P, Maruani A, Maisonneuve H, Giraudeau B, Fournier JP (2018) Effects of Discontinuation of Urate-Lowering Therapy: A Systematic Review. J Gen Intern Med. 33(3):358–366PubMed

21.

Mikuls TR, Cheetham TC, Levy GD, Rashid N, Kerimian A, Low KJ, Coburn BW, Redden DT, Saag KG, Foster PJ, Chen L, Curtis JR (2019) Adherence and outcomes with urate-lowering therapy: a site-randomized trial. Am J Med 132(3):354–361PubMed

22.

Hill-McManus D, Soto E, Marshall S, Lane S, Hughes D (2018) Impact of non-adherence on the safety and efficacy of uric acid-lowering therapies in the treatment of gout. Br J Clin Pharmacol. 84(1):142–152PubMed

23.

Shields G, Beard SM (2015) A systematic review of the economic and humanistic burden of gout. PharmacoEconomics 33(10):1029–1047PubMed

24.

Zhu Y, Choi HK, Pandya BJ (2011) Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 63(10):3136–3141PubMed

25.

Scheepers LEJM et al (2018 Apr) (2018) Medication adherence among patients with gout: a systematic review and meta-analysis. Semin Arthritis Rheum. 47(5):689–702PubMed

26.

Li S, Yang H, Guo Y, Wei F, Yang X, Li D et al (2016) Comparative efficacy and safety of urate-lowering therapy for the treatment of hyperuricemia: a systematic review and network meta-analysis. Sci Rep. 6:33082PubMedCentralPubMed

27.

Wu J-Y, Chang YT, Lin YC, Lee CH, Loh EW, Wu MY, Chang YS, Tam KW (2018) Efficacy and safety of lesinurad in patients with hyperuricemia associated with gout: a systematic review and meta-analysis of randomized controlled trials. Pharmacotherapy 38(11):1106–1119PubMed

28.

Franca Gois PH, de Moraes Souza ER (2017) Pharmacotherapy for hyperuricemia in hypertensive patients. Cochrane Database Syst Rev 4(4):CD008652. Published 2017 Apr 13. https://doi.org/10.1002/14651858.CD008652.pub3 CrossRef

29.

Becker MA et al (2005) Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 353(23):2450–2461PubMed

30.

Becker MA, Schumacher HR, Espinoza LR, Wells AF, MacDonald P, Lloyd E et al (2010) The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther. 12(2):R63PubMedCentralPubMed

31.

Givertz MM, Anstrom KJ, Redfield MM, Deswal A, Haddad H, Butler J et al (2015) Effects of Xanthine Oxidase Inhibition in Hyperuricemic Heart Failure Patients: The Xanthine Oxidase Inhibition for Hyperuricemic Heart Failure Patients (EXACT-HF) Study. Circulation. 131(20):1763–1771PubMedCentralPubMed

32.

Goldfarb DS, MacDonald PA, Gunawardhana L, Chefo S, McLean L (2013) Randomized controlled trial of febuxostat versus allopurinol or placebo in individuals with higher urinary uric acid excretion and calcium stones. Clin J Am Soc Nephrol. 8(11):1960–1967PubMedCentralPubMed

33.

Hosoya T, Ogawa Y, Hashimoto H, Ohashi T, Sakamoto R (2016) Comparison of topiroxostat and allopurinol in Japanese hyperuricemic patients with or without gout: a phase 3, multicentre, randomized, double-blind, double-dummy, active-controlled, parallel-group study. J Clin Pharm Ther. 41(3):290–297PubMed

34.

Hosoya T, Sasaki T, Ohashi T (2017) Clinical efficacy and safety of topiroxostat in Japanese hyperuricemic patients with or without gout: a randomized, double-blinded, controlled phase 2b study. Clin Rheumatol. 36(3):649–656PubMed

35.

Huang X, Du H, Gu J, Zhao D, Jiang L, Li X et al (2014) An allopurinol-controlled, multicenter, randomized, double-blind, parallel between-group, comparative study of febuxostat in Chinese patients with gout and hyperuricemia. Int J Rheum Dis. 17(6):679–686PubMed

36.

Kamatani N, Fujimori S, Hada T, Hosoya T, Kohri K, Nakamura T, Ueda T, Yamamoto T, Yamanaka H, Matsuzawa Y (2011) An allopurinol-controlled, randomized, double-dummy, double-blind, parallel between-group, comparative study of febuxostat (TMX-67), a non-purine-selective inhibitor of xanthine oxidase, in patients with hyperuricemia including those with gout in Japan: phase 3 clinical study. J Clin Rheumatol 17(4 Suppl 2):S13–S18PubMed

37.

Naoyuki K et al (2011) An allopurinol-controlled, multicenter, randomized, open-label, parallel between-group, comparative study of febuxostat (TMX-67), a non-purine-selective inhibitor of xanthine oxidase, in patients with hyperuricemia including those with gout in Japan: phase 2 exploratory clinical study. J Clin Rheumatol 17(4 Suppl 2):S44–S49PubMed

38.

Kumar B, Agarwal PK (2013) Comparative evaluation of efficacy and safety profile of febuxostat with allopurinol in patients with hyperuricemia and gout. Int J Pharm Med Biol Sci 2(4):52–56

39.

Nakagomi A et al (2015) Effects of febuxostat and allopurinol on the inflammation and cardiac function in chronic heart failure patients with hyperuricemia. IJC Metab Endocrine 8:46–55

40.

Perez-Ruiz F, Calabozo M, Fernandez-Lopez MJ, Herrero-Beites A, Ruiz-Lucea E, Garcia-Erauskin G et al (1999) Treatment of chronic gout in patients with renal function impairment: an open, randomized, actively controlled study. J Clin Rheumatol. 5(2):49–55PubMed

41.

Poiley J, Steinberg AS, Choi YJ, Davis CS, Martin RL, McWherter CA et al (2016) A randomized, double-blind, active- and placebo-controlled efficacy and safety study of arhalofenate for reducing flare in patients with gout. Arthritis Rheumatol. 68(8):2027–2034PubMedCentralPubMed

42.

Reinders MK, Haagsma C, Jansen TL, van Roon EN, Delsing J, van de Laar MA et al (2009) A randomised controlled trial on the efficacy and tolerability with dose escalation of allopurinol 300-600 mg/day versus benzbromarone 100-200 mg/day in patients with gout. Ann Rheum Dis. 68(6):892–897PubMed

43.

Schumacher HR Jr, Becker MA, Wortmann RL, Macdonald PA, Hunt B, Streit J et al (2008) Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 59(11):1540–1548PubMed

44.

Sezai A, Soma M (2013) Nakata K-i, Hata M, Yoshitake I, Wakui S, et al. Comparison of Febuxostat and Allopurinol for Hyperuricemia in Cardiac Surgery Patients (NU-FLASH Trial). Circulation Journal. 77(8):2043–2049PubMed

45.

White WB et al (2018) Cardiovascular safety of febuxostat or allopurinol in patients with gout. N Engl J Med 378(13):1200–1210PubMed

46.

Xu S, Liu X, Ming J, Chen S, Wang Y, Liu X et al (2015) A phase 3, multicenter, randomized, allopurinol-controlled study assessing the safety and efficacy of oral febuxostat in Chinese gout patients with hyperuricemia. Int J Rheum Dis. 18(6):669–678PubMed

47.

Yu KH, Lai JH, Hsu PN, Chen DY, Chen CJ, Lin HY (2016) Safety and efficacy of oral febuxostat for treatment of HLA-B*5801-negative gout: a randomized, open-label, multicentre, allopurinol-controlled study. Scand J Rheumatol 45(4):304–311PubMedCentralPubMed

48.

Gunawardhana L, Becker MA, Whelton A, Hunt B, Castillo M, Saag K (2018) Efficacy and safety of febuxostat extended release and immediate release in patients with gout and moderate renal impairment: phase II placebo-controlled study. Arthritis Res Ther. 20(1):99PubMedCentralPubMed

49.

Saag KG, Becker MA, Whelton A, Hunt B, Castillo M, Kisfalvi K, Gunawardhana L (2019) Efficacy and safety of febuxostat extended and immediate release in patients with gout and renal impairment: a phase III placebo-controlled study. Arthritis Rheumatol 71(1):143–153PubMed

50.

Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald P, Palo WA, Eustace D, Vernillet L, Joseph-Ridge N (2005) Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: a twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout. Arthritis Rheum 52(3):916–923PubMed

51.

Naoyuki K et al (2011) Placebo-controlled, double-blind study of the non-purine-selective xanthine oxidase inhibitor Febuxostat (TMX-67) in patients with hyperuricemia including those with gout in Japan: phase 3 clinical study. J Clin Rheumatol 17(4 Suppl 2):S19–S26PubMed

52.

Naoyuki K et al (2011) Placebo-controlled double-blind dose-response study of the non-purine-selective xanthine oxidase inhibitor febuxostat (TMX-67) in patients with hyperuricemia (including gout patients) in Japan: late phase 2 clinical study. J Clin Rheumatol 17(4 Suppl 2):S35–S43PubMed

53.

Kimura K, Hosoya T, Uchida S, Inaba M, Makino H, Maruyama S, Ito S, Yamamoto T, Tomino Y, Ohno I, Shibagaki Y, Iimuro S, Imai N, Kuwabara M, Hayakawa H, Ohtsu H, Ohashi Y, FEATHER Study Investigators (2018) Febuxostat therapy for patients with stage 3 CKD and asymptomatic hyperuricemia: a randomized trial. Am J Kidney Dis 72(6):798–810PubMed

54.

Dalbeth N, Saag KG, Palmer WE, Choi HK, Hunt B, MacDonald P, Thienel U, Gunawardhana L (2017) Effects of febuxostat in early gout: a randomized, double-blind, placebo-controlled study. Arthritis Rheumatol 69(12):2386–2395PubMedCentralPubMed

55.

Saag KG, Whelton A, Becker MA, MacDonald P, Hunt B, Gunawardhana L (2016) Impact of febuxostat on renal function in gout patients with moderate-to-severe renal impairment. Arthritis Rheumatol 68(8):2035–2043PubMed

56.

Usharani P, Nutalapati C, Pokuri VK, Kumar CU, Taduri G (2016) A randomized, double-blind, placebo-, and positive-controlled clinical pilot study to evaluate the efficacy and tolerability of standardized aqueous extracts of Terminalia chebula and Terminalia bellerica in subjects with hyperuricemia. Clin Pharmacol Adv Appl 8:51–59

57.

Hosoya T, Ohno I, Nomura S, Hisatome I, Uchida S, Fujimori S, Yamamoto T, Hara S (2014) Effects of topiroxostat on the serum urate levels and urinary albumin excretion in hyperuricemic stage 3 chronic kidney disease patients with or without gout. Clin Exp Nephrol 18(6):876–884PubMedCentralPubMed

58.

Hosoya T, Sasaki T, Hashimoto H, Sakamoto R, Ohashi T (2016) Clinical efficacy and safety of topiroxostat in Japanese male hyperuricemic patients with or without gout: an exploratory, phase 2a, multicentre, randomized, double-blind, placebo-controlled study. J Clin Pharm Ther 41(3):298–305PubMed

59.

Wada T, Hosoya T, Honda D, Sakamoto R, Narita K, Sasaki T, Okui D, Kimura K (2018) Uric acid-lowering and renoprotective effects of topiroxostat, a selective xanthine oxidoreductase inhibitor, in patients with diabetic nephropathy and hyperuricemia: a randomized, double-blind, placebo-controlled, parallel-group study (UPWARD study). Clin Exp Nephrol 22(4):860–870PubMed

60.

Reinders MK, van Roon E, Jansen TL, Delsing J, Griep EN, Hoekstra M, van de Laar M, Brouwers JR (2009) Efficacy and tolerability of urate-lowering drugs in gout: a randomised controlled trial of benzbromarone versus probenecid after failure of allopurinol. Ann Rheum Dis 68(1):51–56PubMed

61.

Tausche AK et al (2017) Lesinurad monotherapy in gout patients intolerant to a xanthine oxidase inhibitor: a 6 month phase 3 clinical trial and extension study. Rheumatology (United Kingdom) 56(12):2170–2178

62.

Sundy JS, Becker MA, Baraf HS, Barkhuizen A, Moreland LW, Huang W, Waltrip RW 2nd, Maroli AN, Horowitz Z, Pegloticase Phase 2 Study Investigators (2008) Reduction of plasma urate levels following treatment with multiple doses of pegloticase (polyethylene glycol-conjugated uricase) in patients with treatment-failure gout: results of a phase II randomized study. Arthritis Rheum 58(9):2882–2891PubMed

63.

Sundy JS et al (2011) Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA 306(7):711–720PubMed

64.

Bardin T, Keenan RT, Khanna PP, Kopicko J, Fung M, Bhakta N, Adler S, Storgard C, Baumgartner S, So A (2017) Lesinurad in combination with allopurinol: a randomised, double-blind, placebo-controlled study in patients with gout with inadequate response to standard of care (the multinational CLEAR 2 study). Ann Rheum Dis 76(5):811–820PubMed

65.

Perez-Ruiz F, Sundy JS, Miner JN, Cravets M, Storgard C, RDEA594-203 Study Group (2016) Lesinurad in combination with allopurinol: results of a phase 2, randomised, double-blind study in patients with gout with an inadequate response to allopurinol. Ann Rheum Dis 75(6):1074–1080PubMed

66.

Saag KG, Fitz-Patrick D, Kopicko J, Fung M, Bhakta N, Adler S, Storgard C, Baumgartner S, Becker MA (2017) Lesinurad combined with allopurinol: a randomized, double-blind, placebo-controlled study in gout patients with an inadequate response to standard-of-care allopurinol (a US-based study). Arthritis Rheumatol 69(1):203–212PubMed

67.

Dalbeth N et al (2017) Lesinurad, a selective uric acid reabsorption inhibitor, in combination with febuxostat in patients with tophaceous gout: findings of a phase III clinical trial. Arthritis Rheumatol 69(9):1903–1913PubMedCentralPubMed

68.

Deeks JJ, Higgins JPT, Altman DG (2011) Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S, ed. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration

69.

Stamp LK, Chapman PT (2014) Urate-lowering therapy: current options and future prospects for elderly patients with gout. Drugs Aging 31(11):777–786PubMed

70.

Drivelegka P, Sigurdardottir V, Svard A, Jacobsson LTH, Dehlin M (2018) Comorbidity in gout at the time of first diagnosis: sex differences that may have implications for dosing of urate lowering therapy. Arthritis Res Ther. 20(1):108PubMedCentralPubMed

71.

Harrold LR, Etzel CJ, Gibofsky A, Kremer JM, Pillinger MH, Saag KG et al (2017) Sex differences in gout characteristics: tailoring care for women and men. BMC Musculoskelet Disord. 18(1):108PubMedCentralPubMed

72.

Singh JA (2018) Goals of gout treatment: a patient perspective. Clin Rheumatol 37(9):2557–2566PubMed

73.

Ko TM, Tsai CY, Chen SY, Chen KS, Yu KH, Chu CS et al (2015) Use of HLA-B*58:01 genotyping to prevent allopurinol induced severe cutaneous adverse reactions in Taiwan: national prospective cohort study. BMJ. 351:h4848PubMedCentralPubMed

74.

Ramasamy SN, Korb-Wells CS, Kannangara DR, Smith MW, Wang N, Roberts DM, Graham GG, Williams KM, Day RO (2013) Allopurinol hypersensitivity: a systematic review of all published cases, 1950-2012. Drug Saf 36(10):953–980PubMed

75.

Latif Z, Abhishek A (2018) Are doctors the best people to manage gout? Is there a role for nurses and pharmacists? Curr Rheumatol Rep 20(3):14PubMed

76.

Solomon DH et al (2008) Uric acid lowering therapy: prescribing patterns in a large cohort of older adults. Ann Rheum Dis. 67(5):609–613PubMed

77.

Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, Punzi L, So AK, Bardin T (2012) Gout: why is this curable disease so seldom cured? Ann Rheum Dis 71(11):1765–1770PubMed

78.

Yin R et al (2017) The rate of adherence to urate-lowering therapy and associated factors in Chinese gout patients: a cross-sectional study. Rheumatol Int 1187–1194

79.

De Vera MA et al (2014) Medication adherence in gout: a systematic review. Arthritis Care Res 66(10):1551–1559

80.

Cottrell E et al (2013) Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice. BMC Fam Pract 14:170PubMedCentralPubMed

81.

Spaetgens B et al (2016) Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice. Clin Rheumatol 35(8):2053–2061PubMedCentralPubMed

82.

Latourte A, Bardin T, Clerson P, Ea HK, Flipo RM, Richette P (2018) Dyslipidemia, alcohol consumption, and obesity as main factors associated with poor control of urate levels in patients receiving urate-lowering therapy. Arthritis Care Res 70(6):918–924

83.

Ridker PM, Torres J (2006) Reported outcomes in major cardiovascular clinical trials funded by for-profit and not-for-profit organizations: 2000-2005. J Am Med Assoc 295(19):2270–2274

84.

Montaner JSG, O'Shaughnessy MV, Schechter MT (2001) Industry-sponsored clinical research: a double-edged sword. Lancet 358(9296):1893–1895PubMed

Titel: Evaluation of urate-lowering therapy in hyperuricemia patients: a systematic review and Bayesian network meta-analysis of randomized controlled trials
verfasst von: Yu-Jiun Lin
Shiyng-Yu Lin
Chang-Hsien Lin
Sen-Te Wang
Shy-Shin Chang
Publikationsdatum: 21.01.2020
Verlag: Springer London
Erschienen in: Clinical Rheumatology / Ausgabe 5/2020
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04893-8

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