A 12-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial for Evaluation of the Efficacy and Safety of DKB114 on Reduction of Uric Acid in Serum

This study sought to investigate the antihyperuricemia efficacy and safety of DKB114 (a mixture of Chrysanthemum indicum Linn flower extract and Cinnamomum cassia extract) to evaluate its potential as a dietary supplement ingredient. This clinical trial was a randomized, 12-week, double-blind, placebo-controlled study. A total of 80 subjects (40 subjects with an intake of DKB114 and 40 subjects with that of placebo) who had asymptomatic hyperuricemia (7.0–9.0 mg/dL with serum uric acid) was randomly assigned. No significant difference between the DKB114 and placebo groups was observed in the amount of uric acid in serum after six weeks of intake. However, after 12 weeks of intake, the uric acid level in serum of subjects in the DKB114 group decreased by 0.58 ± 0.86 mg/dL and was 7.37 ± 0.92 mg/dL, whereas that in the placebo group decreased by 0.02 ± 0.93 mg/dL and was 7.67 ± 0.89 mg/dL, a significant difference (p = 0.0229). In the analysis of C-reactive protein (CRP) change, after 12 weeks of administration, the DKB114 group showed an increase of 0.05 ± 0.27 mg/dL (p = 0.3187), while the placebo group showed an increase of 0.10 ± 0.21 mg/dL (p = 0.0324), a statistically significant difference (p = 0.0443). In the analysis of amount of change in apoprotein B, after 12 weeks of administration, the DKB114 group decreased by 4.75 ± 16.69 mg/dL (p = 0.1175), and the placebo group increased by 3.13 ± 12.64 mg/dL (p = 0.2187), a statistically significant difference between the administration groups (p = 0.0189). In the clinical pathology test, vital signs and weight measurement, and electrocardiogram test conducted for safety evaluation, no clinically significant difference was found between the ingestion groups, confirming the safety of DKB114. Therefore, it may have potential as a treatment for hyperuricemia and gout. We suggest that DKB114 as a beneficial and safe food ingredient for individuals with high serum uric acid. Trial registration (CRIS.NIH. go. Kr): KCT0002840.

Comparative analysis of the efficacy of angiotensin II receptor blockers for uric acid level change in asymptomatic hyperuricaemia

WHAT IS KNOWN AND OBJECTIVE

There is much controversy over how angiotensin II receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEI) affect blood uric acid levels. Though ARB is not used to lorcwer the uric acid concentration in the blood, losartan, one of the ARB series, is known to reduce the uric acid concentration in the blood and is a preferred drug for hypertensive patients with gout. However, there is no clear conclusive consideration which ARB should be selected for the patients who have simply increased uric acid concentration, other than gout patients. This research aims to compare the variations of the uric acid concentration in the blood in accordance with the prescription of ACEI or ARB targeting patients who were not diagnosed with gout.

METHODS

This research was conducted on the patients who were, for the first time, prescribed ACEI or ARB for a total of 7 years from January 2009 to December 2015. This study has extracted the uric acid values after between 60 days and 120 days (average 90 days, defined as Visit 1) on the basis of the first prescription date of ACEI or ARB.

RESULTS AND DISCUSSION

In this study, ACEI was 17.0% of usage (3787/22 293 patients) and ARB was 83.0% (18 506/22 293 patients). Unlike ACEI (5.91 ± 0.03 vs 5.86 ± 0.03 mg/dL, P = .059), ARB showed a statistically significant decrease after 3 months (5.71 ± 0.01 vs 5.69 ± 0.01 mg/dL, P = .023). In the case of irbesartan (n = 1530, 6.13 ± 0.06 mg/dL vs 5.89 ± 0.05 mg/dL, P < .001) and olmesartan (n = 2719, 5.70 ± 0.04 mg/dL vs 5.63 ± 0.03 mg/dL, P = .008), the decrease in the uric acid after 3 months was revealed as statistically significant. In elderly aged over 60 years, only irbesartan (n = 855, 5.75 ± 0.07 mg/dL vs 5.59 ± 0.07 mg/dL, P = .006) showed a significant decrease in the uric. When the eGFR was less than 60 mL/min/1.73 m² , both ACEI (n = 1108, 6.95 ± 0.07 mg/dL vs 6.73 ± 0.07 mg/dL, P = .001) and ARB (n = 5280, 6.88 ± 0.03 vs 6.60 mg/dL ± 0.03 mg/dL, P < .001) showed a significant decrease in the uric acid.

WHAT IS NEW AND CONCLUSION

Although all types of ACEIs and ARBs are being prescribed with similar purposes, ARB (or ACEI) medication does not have a class effect and has varying effects on uric acid levels. The decreases in uric acid levels were relatively small. ARBs seem to be more advantageous than ACEIs for hyperuricaemia patients without gout who are aiming to maintain uric acid decrease levels. Furthermore, irbesartan can be a good substitute for losartan in view of the fact that at least the uric acid level is not increased.