Network Meta-Analysis of Drug Therapies for Lowering Uric Acid and Mortality Risk in Patients with Heart Failure
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ORIGINAL ARTICLE
Network Meta-Analysis of Drug Therapies for Lowering Uric Acid and Mortality Risk in Patients with Heart Failure Satoru Kodama 1 & Kazuya Fujihara 2 & Chika Horikawa 3 & Mayuko Yamada 2 & Takaaki Sato 2 & Yuta Yaguchi 2 & Masahiko Yamamoto 2 & Masaru Kitazawa 2 & Yasuhiro Matsubayashi 2 & Takaho Yamada 2 & Kenichi Watanabe 1 & Hirohito Sone 2 Accepted: 11 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This network meta-analysis aimed to assess the current efficacy of decreasing the uric acid (UA) level with drugs to reduce mortality in patients with heart failure (HF). Methods Electronic literature searches using EMBASE and MEDLINE of studies published from 1 Jan 1950 to 26 Dec 2019 were conducted for randomized controlled trials or non-randomized cohort studies that included at least one group of patients who took UA-lowering drugs and with a study outcome of all-cause mortality. A random-effects network meta-analysis was performed within a frequentist framework. Hierarchy of treatments was expressed as the surface under the cumulative ranking curve (SUCRA) value, which is in proportion to mean rank (best is 100%). Results Nine studies, which included seven different types of groups, were eligible for analysis. The “untreated uricemia” group in which patients had hyperuricemia but without treatment had a significantly higher risk of mortality than the “no uricemia” group in which patients had no hyperuricemia (relative risk (RR)(95% confidence interval (CI), 1.43 (1.08–1.89)). The “startallo” group wherein patients started to take allopurinol did not have a significantly lower risk of mortality than the “untreated uricemia” group (RR (95% CI), 0.68 (0.45–1.01)). However, in the “start-allo” group the SUCRA value was comparable to that in the “no uricemia” group (SUCRA: 65.4% for “start-allo”; 64.1% for “no uricemia”). Conclusions Results suggested that allopurinol therapy was not associated with a significantly improved prognosis in terms of mortality but could potentially counteract the adverse effects associated with longstanding hyperuricemia in HF patients. Keywords Network meta-analysis . Hyperuricemia . Uric acid . Heart failure
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07097-4) contains supplementary material, which is available to authorized users. * Satoru Kodama [email protected] 1
Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori Chuoh-ku, Niigata-shi, Niigata, Japan
2
Department of Hematology, Endocrinology and Metabolism, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
3
Department of Health and Nutrition, Faculty of Human Life Studies, University of Niigata Prefecture, Niigata, Japan
Heart failure (HF) is a worldwide public health concern. Survival after a diagnosis of HF remains quite poor.
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