Quantitative evaluation of clinical efficacy and safety of uric acid-lowering drugs: A modeling analysis of literature aggregate data
Authors' conclusion
This study provides a comprehensive quantitative analysis of the efficacy and safety characteristics of urate-lowering drugs, offering important evidence for optimizing treatment strategies for gout and hyperuricemia.
Study context
- Population
- Clinical trials of urate-lowering drugs for hyperuricemia or gout (PubMed, Embase, Cochrane Library to May 26, 2024)
- Participants
- 10,591 participants49 studies
- Comparison
- Urate-lowering drug classes: Xanthine oxidase inhibitor (XOI) vs URAT1 inhibitor vs uricase
- Outcome
- Time course of serum uric acid reduction rate
- Follow-up
- 3 months
Methodological detailsmodel-based meta-analysis (MBMA), subgroup analyses by dosage, formulation and population
- Model-based meta-analysis (MBMA)
- Subgroup analyses by dosage, formulation and population
Pooled result
As reported in the abstract
Serum uric acid reduction
| Group | Value | Efficacy plateau |
|---|---|---|
| XOI | 35.4 % | week 7 |
| URAT1 | 37.5 % | week 10 |
| URICASE | 79.6 % | immediately |
Value
XOI35.4 %
URAT137.5 %
URICASE79.6 %
Efficacy plateau
XOIweek 7
URAT1week 10
URICASEimmediately
Further pooled results
Dropout rate (compliance)
%
| Outcome | XOI | URAT1 | URICASE |
|---|---|---|---|
| Gout attack rate · within 3 months | 18.9 | — not stated in the abstract | 51.2 |
| Gout attack rate · 1 year | 7.4 | — not stated in the abstract | 13.3 |
| Change in eGFR · 1 year | 0.7 | −2.5 | — not stated in the abstract |
— not stated in the abstract
Subgroups: dose, dosing and formulation
- Clear dose-response relationship for urate-lowering effects of XOI and URAT1
- Flexible dosing superior to fixed dosing
- Sustained-release outperforming immediate-release formulations
- Higher doses associated with increased rate of gout attacks
Safety
AEs
SAEs
Original publication
Quantitative evaluation of clinical efficacy and safety of uric acid-lowering drugs: A modeling analysis of literature aggregate data. Semin Arthritis Rheum. Published 5 August 2025. doi:10.
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