J Rheum Dis.  2015 Dec;22(6):356-365. 10.4078/jrd.2015.22.6.356.

Comparative Efficacy and Safety of Febuxostat and Allopurinol in the Treatment of Hyperuricemia: A Bayesian Network Meta-analysis

• Song GG
• Lee YH

• KMID: 2222809
• DOI: http://doi.org/10.4078/jrd.2015.22.6.356

Abstract

OBJECTIVE
The aim of this study was to assess the relative urate-lowering efficacy and safety of febuxostat and allopurinol in hyperuricemic patients with or without gout.
METHODS
Randomized controlled trials (RCTs) examining the efficacy and safety of febuxostat compared to allopurinol or placebo in hyperuricemic patients with/without gout were included in this Bayesian network meta-analysis.
RESULTS
Eight RCTs including 4,099 patients met the inclusion criteria. The number of subjects achieving a serum urate (sUA) level <6.0 mg/dL was significantly higher in the febuxostat 120 mg and 80 mg groups than in the allopurinol (100 to 300 mg) group (odds ratio [OR] 7.17, 95% credible interval [CrI] 3.86 to 14.09; OR 3.49, 95% CrI 1.97 to 5.91, respectively). However, achievement of the target sUA level was comparable between febuxostat 40 mg and allopurinol. Ranking probability based on surface under the cumulative ranking curve (SUCRA) indicated that febuxostat 120 mg had the highest probability of being the best treatment for achieving the target sUA (SUCRA=0.9973), followed by febuxostat 80 mg (SUCRA=0.752), febuxostat 40 mg (SUCRA=0.4289), allopurinol (SUCRA=0.3217), and placebo (SUCRA=0). In contrast, no significant difference in safety based on the number of withdrawals due to adverse events was observed among the 5 interventions.
CONCLUSION
Febuxostat 80 mg and 120 mg were more efficacious than allopurinol (100 to 300 mg), and febuxostat 40 mg and allopurinol were comparable in urate-lowering efficacy. The safety of febuxostat at all doses was comparable with that of allopurinol.

Keyword

Febuxostat; Allopurinol; Gout; Meta-analysis

MeSH Terms

Allopurinol*
Gout
Humans
Hyperuricemia*
Uric Acid
Febuxostat
Allopurinol
Uric Acid

Figure

• 

  Figure 1. Evidence network diagram of network meta-analysis comparisons. The width of each edge is proportional to the number of randomized controlled trials comparing each pair of treatments, and the size of each treatment node is proportional to the number of randomized participants (sample size).(A) Febuxostat 40 mg. (B) Febuxostat 80 mg. (C) Febuxostat 120 mg. (D) Allopurinol. (E) Placebo.

• 

  Figure 2. League tables showing the results of the network metaanalyses comparing the effects of all drugs including odds ratio (OR) and 95% credible intervals. (A) Efficacy; OR ＞1 means the top-left treatment is better. (B) Safety; OR ＜1 means the top-left treatment is better.

• 

  Figure 3. Bayesian network meta-analysis results of randomized controlled studies on the relative efficacy (A) and safety (B) of febuxostat, allopurinol, and placebo, respectively. CrI: credible interval, OR: odds ratio.

• 

  Figure 4. Inconsistency plots for efficacy (A) and safety (B) of febuxostat, allopurinol, and placebo. Plot of the posterior mean deviance contribution of individual data points for the consistency model (horizontal axis) and the unrelated mean effects model (vertical axis), along with the line of equality.

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