Quantitative evaluation of clinical efficacy and safety of uric acid-lowering drugs: A modeling analysis of literature aggregate data.

Objective: To quantitatively assess and compare the efficacy and safety characteristics of different urate-lowering drugs, focusing on their dosage, formulation, and effects in various populations, in order to support and optimize current urate-lowering treatment strategies.

Methods: Clinical trials on urate-lowering drug treatments for hyperuricemia or gout were retrieved from PubMed, Embase, and Cochrane Library databases from the inception of the database until May 26, 2024. A model-based meta-analysis (MBMA) was conducted to quantitatively analyze the time effects of serum uric acid reduction rates and gout attack rates following urate-lowering drug interventions, along with their influencing factors. Additionally, a single-arm meta-analysis was performed to summarize the proportion of patients achieving serum uric acid levels below 6 mg/dl, estimated glomerular filtration rate (eGFR), adverse events (AEs), serious adverse events (SAEs) and dropout rate. Subgroup analyses were conducted to compare the efficacy and safety characteristics of urate-lowering drugs across different dosages, formulations, and populations.

Results: A total of 49 studies involving 10,591 participants were included, assessing nine drugs across three categories: xanthine oxidase inhibitor (XOI), Urate transporter 1 inhibitor (URAT1), and Urate oxidase (URICASE). Results indicated that after three months, uric acid levels decreased by 35.4 %, 37.5 %, and 79.6 % for XOI, URAT1, and URICASE, respectively, with efficacy platforms reached at weeks 7, 10, and immediately. Within three months of intervention, the gout attack rates for XOI and URICASE were 18.9 % and 51.2 %, respectively; after one year, these rates decreased to 7.4 % and 13.3 %. The changes in eGFR after one year of intervention were 0.7 % for XOI and -2.5 % for URAT1. In terms of safety, the incidence rates of AEs were 55.8 %, 51.8 %, and 92.4 % for XOI, URAT1, and URICASE, respectively, while the SAEs were 4 %, 2.4 %, and 18.8 %. Patient compliance was described in terms of dropout rates, which were 17 %, 8 % and 31 % for XOI, URAT1 and URICASE, respectively. Subgroup analyses revealed a clear dose-response relationship for the urate-lowering effects of XOI and URAT1, with flexible dosing showing superior efficacy compared to fixed dosing, and sustained-release formulations outperforming immediate-release formulations. However, higher doses were associated with an increased rate of gout attacks.

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.