1
|
Girigoswami K, Arunkumar R, Girigoswami A. Management of hypertension addressing hyperuricaemia: introduction of nano-based approaches. Ann Med 2024; 56:2352022. [PMID: 38753584 PMCID: PMC11100442 DOI: 10.1080/07853890.2024.2352022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Uric acid (UA) levels in blood serum have been associated with hypertension, indicating a potential causal relationship between high serum UA levels and the progression of hypertension. Therefore, the reduction of serum UA level is considered a potential strategy for lowering and mitigating blood pressure. If an individual is at risk of developing or already manifesting elevated blood pressure, this intervention could be an integral part of a comprehensive treatment plan. By addressing hyperuricaemia, practitioners may subsidize the optimization of blood pressure regulation, which illustrates the importance of addressing UA levels as a valuable strategy within the broader context of hypertension management. In this analysis, we outlined the operational principles of effective xanthine oxidase inhibitors for the treatment of hyperuricaemia and hypertension, along with an exploration of the contribution of nanotechnology to this field.
Collapse
Affiliation(s)
- Koyeli Girigoswami
- Medical Bionanotechnology, Faculty of Allied Health Sciences, Chettinad Hospital & Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Chennai, India
| | - Radhakrishnan Arunkumar
- Department of Pharmacology, Chettinad Hospital & Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Chennai, India
| | - Agnishwar Girigoswami
- Medical Bionanotechnology, Faculty of Allied Health Sciences, Chettinad Hospital & Research Institute (CHRI), Chettinad Academy of Research and Education (CARE), Chennai, India
| |
Collapse
|
2
|
Nowak MM, Niemczyk M, Gołębiewski S, Pączek L. Influence of xanthine oxidase inhibitors on all-cause mortality in adults: a systematic review and meta-analysis. Cardiol J 2024:VM/OJS/J/97807. [PMID: 38771265 DOI: 10.5603/cj.97807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/05/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Xanthine oxidase inhibitors, including allopurinol and febuxostat, are the first-line treatment of hyperuricemia. This meta-analysis investigated the association between urate-lowering therapy and all-cause mortality in different chronic diseases to match its users and non-users in a real-world setting. Overall, 11 studies were included, which reported adjusted hazard ratios for all-cause mortality over at least 12 months. Meta-analysis of all included studies showed no effect of the therapy on all-cause mortality. However, subgroup analyses showed its beneficial effect in patients with chronic kidney disease (14% risk reduction) and hyperuricemia (14% risk reduction), but not in patients with heart failure (28% risk increase). Urate-lowering therapy reduces all-cause mortality among patients with hyperuricemia and chronic kidney disease, but it seems to increase mortality in patients with heart failure and should be avoided in this subgroup.
Collapse
Affiliation(s)
- Marcin M Nowak
- Department of Interventional Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Legionowo, Poland
| | - Mariusz Niemczyk
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Poland
| | - Sławomir Gołębiewski
- Department of Interventional Cardiology and Internal Diseases, Military Institute of Medicine - National Research Institute, Legionowo, Poland
| | - Leszek Pączek
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Poland.
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland.
| |
Collapse
|
3
|
Kang EH, Shin A, Park CS, Lee EB, Lee YJ, Curhan G, Choi HK. Risk of urolithiasis associated with allopurinol versus benzbromarone among patients with gout: a population-based cohort study. Rheumatology (Oxford) 2024:keae262. [PMID: 38733596 DOI: 10.1093/rheumatology/keae262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES To compare the risk of urolithiasis in gout patients initiating allopurinol, a xanthine oxidase inhibitor, vs benzbromarone, a uricosuric. METHODS Using the 2011-2020 Korea National Health Insurance Service database, we conducted a cohort study on gout patients initiating allopurinol vs benzbromarone as the 1st-line urate-lowering treatment (ULT). The primary outcome was a new onset urinary stone. The secondary outcome was a stone requiring intervention. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazard models with a 5:1 ratio propensity-score matching on > 80 variables. Subgroup analyses were done by age, sex, thiazide use, and cardiovascular (CV) risk. RESULTS 61 300 allopurinol initiators PS-matched on 12 260 benzbromarone initiators were included (mean age 59 years, 79% male). During a mean follow-up of 322 days, 619 urolithiasis cases occurred with an incidence rate of 0.87 per 100 person-years in allopurinol and 1.39 in benzbromarone initiators, showing a HR of 0.64 (95% CI, 0.51-0.80). ∼44% of urinary stones required intervention with a HR of 0.61 (95% CI 0.43-0.88). The lower risk associated with allopurinol compared with benzbromarone persisted across subgroups but was greater in the high than non-high CV risk subgroup (p for interaction = 0.02). CONCLUSION This population-based cohort study found that allopurinol compared with benzbromarone was associated with a substantially lower risk of urolithiasis particularly in the presence of the high CV risk. This finding provides important safety information for clinicians' decision-making on ULTs of different mechanisms of action.
Collapse
Affiliation(s)
- Eun Ha Kang
- Division of Rheumatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Anna Shin
- Division of Rheumatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Soo Park
- Division of Rheumatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Bong Lee
- Division of Rheumatology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yun Jong Lee
- Division of Rheumatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gary Curhan
- Channing Division of Network Medicine and Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hyon K Choi
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Dalbeth N, Te Karu L, Stamp LK. Gout and its management. Intern Med J 2024; 54:716-723. [PMID: 38654576 DOI: 10.1111/imj.16382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/27/2024] [Indexed: 04/26/2024]
Abstract
Gout is a common and treatable chronic disease of monosodium urate crystal deposition. It is experienced as extremely painful episodes of joint inflammation that impact all aspects of the person's life. This Clinical Perspectives article provides an update on gout diagnosis, medications and strategies to improve the quality of gout care.
Collapse
Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Leanne Te Karu
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| |
Collapse
|
5
|
Wright DFB, Hishe HZ, Stocker SL, Dalbeth N, Horne A, Drake J, Haslett J, Phipps-Green AJ, Merriman TR, Stamp LK. The development and evaluation of dose-prediction tools for allopurinol therapy (Easy-Allo tools). Br J Clin Pharmacol 2024; 90:1268-1279. [PMID: 38359899 DOI: 10.1111/bcp.16005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
AIMS Dose escalation at the initiation of allopurinol therapy can be protracted and resource intensive. Tools to predict the allopurinol doses required to achieve target serum urate concentrations would facilitate the implementation of more efficient dose-escalation strategies. The aim of this research was to develop and externally evaluate allopurinol dosing tools, one for use when the pre-urate-lowering therapy serum urate is known (Easy-Allo1) and one for when it is not known (Easy-Allo2). METHODS A revised population pharmacokinetic-pharmacodynamic model was developed using data from 653 people with gout. Maintenance doses to achieve the serum urate target of <0.36 mmol L-1 in >80% of individuals were simulated and evaluated against external data. The predicted and observed allopurinol doses were compared using the mean prediction error (MPE) and root mean square error (RMSE). The proportion of Easy-Allo predicted doses within 100 mg of the observed was quantified. RESULTS Allopurinol doses were predicted by total body weight, baseline urate, ethnicity and creatinine clearance. Easy-Allo1 produced unbiased and suitably precise dose predictions (MPE 2 mg day-1 95% confidence interval [CI] -13-17, RMSE 91%, 90% within 100 mg of the observed dose). Easy-Allo2 was positively biased by about 70 mg day-1 and slightly less precise (MPE 70 mg day-1 95% CI 52-88, RMSE 131%, 71% within 100 mg of the observed dose). CONCLUSIONS The Easy-Allo tools provide a guide to the allopurinol maintenance dose requirement to achieve the serum urate target of <0.36 mmol L-1 and will aid in the development of novel dose-escalation strategies for allopurinol therapy.
Collapse
Affiliation(s)
- Daniel F B Wright
- School of Pharmacy, University of Otago, Dunedin, New Zealand
- Sydney Pharmacy School, University of Sydney, Sydney, Australia
| | - Hailemichael Z Hishe
- School of Pharmacy, University of Otago, Dunedin, New Zealand
- School of Pharmacy, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Sophie L Stocker
- Sydney Pharmacy School, University of Sydney, Sydney, Australia
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney, Darlinghurst, Australia
- Musculoskeletal Health, University of Sydney, Sydney, Australia
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Anne Horne
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Jill Drake
- Department of Rheumatology, Immunology and Allergy, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Janine Haslett
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lisa K Stamp
- Department of Rheumatology, Immunology and Allergy, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
6
|
Schulz M, Coleshill MJ, Day RO, Wright DFB, Brett J, Briggs NE, Aung E. Estimation of adherence to urate-lowering therapy in people living with gout using Australia's Pharmaceutical Benefits Scheme and patient-reported dosing. Br J Clin Pharmacol 2024; 90:1322-1332. [PMID: 38382554 DOI: 10.1111/bcp.16016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
AIMS The aim of this study was to estimate adherence to urate-lowering therapy (ULT), predominately allopurinol, from Australia's Pharmaceutical Benefits Scheme (PBS) claims database in association with (1) patient-reported doses and (2) World Health Organization's (WHO) defined daily doses (DDD), namely, allopurinol (400 mg/day) or febuxostat (80 mg/day). METHODS Proportion of days covered (PDC) was calculated in 108 Gout App (Gout APP) trial participants with at least two recorded ULT dispensings in an approximately 12-month period before provision of intervention or control apps. Adherence was defined as PDC ≥80%. We measured the correlation between the two methods of calculating PDC using a Wilcoxon signed rank test. Agreement between ULT-taking status (self-reports) and ULT-dispensed status (PBS records) was tested with Cohen's kappa (κ), and positive and negative percent agreement. RESULTS Allopurinol was prescribed in 93.5% of participants taking ULT. Their self-reported mean daily dose (SD) was 291 (167) mg/day. Mean PDC (SD) for allopurinol was 83% (21%) calculated using self-reported dose, and 63% (24%) using WHO's DDD. Sixty-three percent of allopurinol users were identified as adherent (PDC ≥80%) using self-reported dose. There was good agreement between self-reported ULT use and PBS dispensing claims (κ = 0.708, P < .001; positive percent agreement = 90%, negative percent agreement = 82%). CONCLUSIONS Participant-reported allopurinol daily doses, in addition to PBS dispensing claims, may enhance confidence in estimating PDC and adherence compared to using DDD. This approach improves adherence estimations from pharmaceutical claims datasets for medications where daily doses vary between individuals or where there is a wide therapeutic dose range.
Collapse
Affiliation(s)
- Marcel Schulz
- St Vincent's Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Matthew J Coleshill
- St Vincent's Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
| | - Richard O Day
- St Vincent's Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | | | - Jonathan Brett
- St Vincent's Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nancy E Briggs
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, Australia
| | - Eindra Aung
- St Vincent's Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
- Northern Sydney Local Health District, NSW Health, Sydney, NSW, Australia
- Kolling Institute, Pain Management Research Institute, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
7
|
Rotulo GA, Campanello C, Battaglini M, Bassi M, Pastorino C, Angeletti A, Brisca G, Signa S, Caorsi R, Ghiggeri GM. A Rare Pediatric Case of Allopurinol-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Successfully Treated With Intravenous Immunoglobulins. J Pediatr Pharmacol Ther 2024; 29:195-199. [PMID: 38596415 PMCID: PMC11001218 DOI: 10.5863/1551-6776-29.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/28/2022] [Indexed: 04/11/2024]
Abstract
Allopurinol-induced drug reaction syndrome with eosinophilia and systemic symptoms (A-DRESS) is a well-described condition in adults, whereas it is uncommon among children. We describe a case of A-DRESS in a 16-year-old male with steroid-dependent nephrotic syndrome. He presented a life-threatening clinical course with persisting fever, skin rash, eosinophilia, lymphadenopathy, distributive shock, and herpesvirus 6 detection. The withdrawal of allopurinol and a combination of intravenous immunoglobulins (IVIGs) and systemic corticosteroids led to the patient's recovery without sequelae. Drug reaction with eosinophilia and systemic symptoms (DRESS) in pediatrics is rare and can present in a severe form. Early diagnosis and timely treatment are critical for prognostic purposes. This report suggests the potentially crucial role of IVIG in the treatment of patients with A-DRESS.
Collapse
Affiliation(s)
- Gioacchino Andrea Rotulo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
- Clinical and Research Unit of Clinical Immunology and Vaccinology (GAR), IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Claudia Campanello
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
| | - Marcella Battaglini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
| | - Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
| | - Carlotta Pastorino
- Dermatology Unit (CP), Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Andrea Angeletti
- Division of Nephrology, Dialysis, and Transplantation (AA, GMG), Giannina Gaslini Children’s Hospital, Genoa, Italy
| | - Giacomo Brisca
- Subintensive Care Unit (GB), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Signa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (GAR, CC, M Battaglini, M Bassi, SS), University of Genoa, Genoa, Italy
- Autoinflammatory Diseases and Immunodeficiencies Center (SS, RC), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Autoinflammatory Diseases and Immunodeficiencies Center (SS, RC), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis, and Transplantation (AA, GMG), Giannina Gaslini Children’s Hospital, Genoa, Italy
| |
Collapse
|
8
|
Takayama A, Fukasawa T, Takeuchi M, Kawakami K. Timing of Initiation of Xanthine Oxidase Inhibitors Based on Serum Uric Acid Level Does Not Predict Renoprognosis in Patients with Preserved Kidney Function. Metab Syndr Relat Disord 2024; 22:222-231. [PMID: 38170182 DOI: 10.1089/met.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Background: Despite recent evidence of remaining possibility that early initiation of xanthine oxidase inhibitors (XOIs) is beneficial in renoprognosis for patients with stage 2 or less chronic kidney disease (CKD), no evidence is available regarding the difference in renoprognosis based on serum uric acid (sUA) levels at the initiation of XOIs among patients with preserved kidney function. Methods: New XOI initiators were divided into quartiles based on baseline sUA. Primary outcome was the composite incidence of a significant estimated glomerular filtration rate (eGFR) decline (≥40% decline in eGFR from baseline or development of eGFR <30 mL/1.73 m2/min) or all-cause death within 5 years. Results: After excluding inapplicable patients, 1170 XOI initiators were analyzed (mean ± standard deviation age: 68 ± 14.3 years; sUA: 10.6 ± 1.15 mg/dL). On overall median [interquartile range (IQR)] follow-up of 824 (342, 1576) days, incidence rate of the primary outcome was 287 per 1000 person-years for 5 years. Although the nonadjusted model showed a dose-response association between baseline sUA level and the outcome, the adjusted model showed no significant association. Adjusted hazard ratios (95% confidence interval) of the second, third, and fourth quartiles of baseline sUA with the composite outcome within 5 years compared to the first quartile were 1.00 (0.78, 1.29), 1.00 (0.80, 1.30), and 1.02 (0.80, 1.32), respectively. Conclusions: Early initiation of XOIs did not predict a significant benefit on renoprognosis even among the population with preserved kidney function. The validity of initiating XOIs with the aim of improving renoprognosis based on sUA is questionable.
Collapse
Affiliation(s)
- Atsushi Takayama
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| |
Collapse
|
9
|
Casanova AG, Morales AI, Vicente-Vicente L, López-Hernández FJ. Effect of uric acid reduction on chronic kidney disease. Systematic review and meta-analysis. Front Pharmacol 2024; 15:1373258. [PMID: 38601468 PMCID: PMC11005459 DOI: 10.3389/fphar.2024.1373258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Accumulating evidence suggests that hyperuricemia is a pathological factor in the development and progression of chronic kidney disease. However, the potential benefit afforded by the control of uric acid (UA) is controversial. Individual studies show discrepant results, and most existing meta-analysis, especially those including the larger number of studies, lack a placebo or control group as they aim to compare efficacy between drugs. On these grounds, we performed a me-ta-analysis restricted to studies including the action of any anti-gout therapies referenced to a control or placebo arm. This approach allows for a clearer association between UA reduction and renal effect. Of the twenty-nine papers included, most used allopurinol and febuxostat and, therefore, solid conclusions could only be obtained for these drugs. Both were very effective in reducing UA, but only allopurinol was able to significantly improve glomerular filtration rate (GFR), although not in a dose-dependent manner. These results raised doubts as to whether it is the hypouricemic effect of anti-gout drugs, or a pleiotropic effect, what provides protection of kidney function. Accordingly, in a correlation study that we next performed between UA reduction and GFR improvement, no association was found, which suggests that additional mechanisms may be involved. Of note, most trials show large inter-individual response variability, probably because they included patients with heterogeneous phenotypes and pathological characteristics, including different stages of CKD and comorbidities. This highlights the need to sub classify the effect of UA-lowering therapies according to the pathological scenario, in order to identify those CKD patients that may benefit most from them. Systematic Review Registration: CRD42022306646 https://www.crd.york.ac.uk/prospero/.
Collapse
Affiliation(s)
- Alfredo G. Casanova
- Toxicology Unit, Universidad de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL) del Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain
- Department of Physiology and Pharmacology, Universidad de Salamanca (USAL), Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- National Network for Kidney Research REDINREN, RICORS2040 RD21/0005/0004-Instituto de Salud Carlos III, Madrid, Spain
| | - Ana I. Morales
- Toxicology Unit, Universidad de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL) del Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain
- Department of Physiology and Pharmacology, Universidad de Salamanca (USAL), Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- National Network for Kidney Research REDINREN, RICORS2040 RD21/0005/0004-Instituto de Salud Carlos III, Madrid, Spain
- Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain
| | - Laura Vicente-Vicente
- Toxicology Unit, Universidad de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL) del Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain
- Department of Physiology and Pharmacology, Universidad de Salamanca (USAL), Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- National Network for Kidney Research REDINREN, RICORS2040 RD21/0005/0004-Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J. López-Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL) del Instituto de Ciencias de la Salud de Castilla y León (ICSCYL), Salamanca, Spain
- Department of Physiology and Pharmacology, Universidad de Salamanca (USAL), Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- National Network for Kidney Research REDINREN, RICORS2040 RD21/0005/0004-Instituto de Salud Carlos III, Madrid, Spain
- Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain
| |
Collapse
|
10
|
Sosa F, Shaban M, Lopez J, Duarte GJ, Jain S, Khizar A, Vittorio T, Mishra R, Rodriguez Guerra M. Impact of Hyperuricemia and Urate-Lowering Agents on Cardiovascular Diseases. Clin Med Insights Cardiol 2024; 18:11795468241239542. [PMID: 38529322 PMCID: PMC10962038 DOI: 10.1177/11795468241239542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
The association between hyperuricemia and cardiovascular diseases has been studied for many years. Research has shown a link between high uric acid levels and increased risk of including coronary artery disease hypertension and other cardiovascular conditions. Urate-lowering therapy, particularly with xanthine oxidase inhibitors like allopurinol, has shown promising results in reducing blood pressure in individuals with hyperuricemia and hypertension. Clinical trials and studies have demonstrated significant reductions in both systolic and diastolic blood pressure with urate-lowering treatment. Urate-lowering treatment has shown a favorable effect on reducing systolic blood pressure and major adverse cardiovascular events in patients with previous cardiovascular disease. In terms of cardiovascular safety, clinical trials have indicated that xanthine oxidase inhibitors such as febuxostat are non-inferior to allopurinol and do not increase the risk of death or serious adverse events. Overall, these findings highlight the importance of managing hyperuricemia and utilizing urate-lowering therapy to mitigate the adverse cardiovascular effects associated with elevated uric acid levels.
Collapse
Affiliation(s)
- Franklin Sosa
- BronxCare Health System, Icahn School of Medicine, Bronx, NY, USA
| | - Mohammed Shaban
- BronxCare Health System, Icahn School of Medicine, Bronx, NY, USA
| | - Jose Lopez
- Division of Cardiovascular Disease, University of Miami Miller School of Medicine/JFK Hospital, Atlantis, FL, USA
| | - Gustavo J. Duarte
- Division of Cardiology, Cleveland Clinic Florida, Fort Lauderdale, FL, USA
| | - Swati Jain
- Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, USA
| | - Asma Khizar
- Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, USA
| | - Timothy Vittorio
- BronxCare Health System, Icahn School of Medicine, Bronx, NY, USA
| | - Rishabh Mishra
- Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, USA
| | | |
Collapse
|
11
|
Santos AG, Kühl CE, Higashijima AN, Kanazawa LKS, de Souza STF, Andreatini R. Antimanic-like effect of dipyridamole in the methylphenidate-induced hyperlocomotion. Fundam Clin Pharmacol 2024. [PMID: 38472106 DOI: 10.1111/fcp.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Adenosinergic system has been implicated in the pathophysiology of bipolar disorder and drugs that affect adenosine neurotransmission have shown some efficacy as add-on therapy in manic patients. OBJECTIVE Thus, the aim of the present study was to screen adenosinergic drugs for antimanic-like effect in methylphenidate (MPH)-induced hyperlocomotion in mice. METHODS Male and female Swiss mice received a single allopurinol (50 and 200 mg/kg, ip), dipyridamole (20 mg/kg, ip), or inosine (50 mg/kg, ip) administration before an acute MPH challenge (5 mg/kg, sc). In experiments with repeated treatment, male mice received a daily administration of allopurinol (25 and 50 mg/kg, ip), dipyridamole (20 mg/kg, ip), or inosine (50 mg/kg, ip) for 14 days. Finally, pretreatment with aminophylline (2 mg/kg, sc), an unspecific adenosine receptor antagonist, was used to evaluate a putative adenosinergic mediation. Locomotor activity was measured in the automated activity chamber for 20 min. RESULTS Acute and repeated dipyridamole reduced the increase in locomotor activity induced by MPH, while allopurinol and inosine had no effect. Aminophylline blocked the effect of dipyridamole in MPH-induced hyperlocomotion. CONCLUSION The present results suggest that dipyridamole may have an antimanic-like effect through adenosine receptors and reinforce the proposal that the adenosine system may be an interesting target for new antimanic drugs.
Collapse
Affiliation(s)
- Anderson Gustavo Santos
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, Curitiba, PR, Brazil
| | - Carlos Eduardo Kühl
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, Curitiba, PR, Brazil
| | - Arisa Namie Higashijima
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, Curitiba, PR, Brazil
| | - Luiz Kae Sales Kanazawa
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, Curitiba, PR, Brazil
| | - Suzen Tortato Furtado de Souza
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, Curitiba, PR, Brazil
| | - Roberto Andreatini
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, Curitiba, PR, Brazil
| |
Collapse
|
12
|
Mitsuboshi S, Morizumi M, Kotake K, Kaseda R, Narita I. Urate-Lowering Drugs and Muscle Injury: A Systematic Review and Network Meta-Analysis. J Clin Pharmacol 2024; 64:288-299. [PMID: 37840156 DOI: 10.1002/jcph.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
Several urate-lowering drugs have been linked to muscle injury. This study investigated the association of oral urate-lowering drugs with the risk of muscle injury by performing a network meta-analysis of randomized and non-randomized controlled trials. A systematic search of MEDLINE, via PubMed, the ClinicalTrials.gov website, and the Cochrane Central Register of Controlled Trials was conducted to identify relevant studies with a primary outcome of "all muscle injuries." A random-effects model was used to perform a frequentist network meta-analysis to estimate whether there was significant heterogeneity among the studies. In total, 32 studies including 28,327 participants with 2694 (9.5%) "all muscle injuries" were assessed, and the overall risk of bias was judged to be low to moderate. No statistically significant differences were found between placebo and 6 urate-lowering therapies: allopurinol (risk ratio, RR, 1.05; 95% confidence interval, 95%CI, 0.63-1.73), febuxostat (RR 1.10, 95%CI 0.71-1.70), lesinurad (RR 7.00, 95%CI 0.31-160.36), lesinurad concomitant with allopurinol (RR 0.85, 95%CI 0.34-2.11), lesinurad concomitant with febuxostat (RR 1.97, 95%CI 0.55-7.03), and topiroxostat (RR 0.99, 95%CI 0.37-2.65). The findings suggest that there is little need to consider the risk of muscle injury when using urate-lowering drugs in the clinical setting.
Collapse
Affiliation(s)
| | - Makoto Morizumi
- Department of Pharmacy, Ohno Memorial Hospital, Osaka, Japan
| | - Kazumasa Kotake
- Department of Pharmacy, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Ryohei Kaseda
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
13
|
Worledge CS, Kostelecky RE, Zhou L, Bhagavatula G, Colgan SP, Lee JS. Allopurinol Disrupts Purine Metabolism to Increase Damage in Experimental Colitis. Cells 2024; 13:373. [PMID: 38474337 PMCID: PMC10930830 DOI: 10.3390/cells13050373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Inflammatory bowel disease (IBD) is marked by a state of chronic energy deficiency that limits gut tissue wound healing. This energy shortfall is partially due to microbiota dysbiosis, resulting in the loss of microbiota-derived metabolites, which the epithelium relies on for energy procurement. The role of microbiota-sourced purines, such as hypoxanthine, as substrates salvaged by the colonic epithelium for nucleotide biogenesis and energy balance, has recently been appreciated for homeostasis and wound healing. Allopurinol, a synthetic hypoxanthine isomer commonly prescribed to treat excess uric acid in the blood, inhibits the degradation of hypoxanthine by xanthine oxidase, but also inhibits purine salvage. Although the use of allopurinol is common, studies regarding how allopurinol influences the gastrointestinal tract during colitis are largely nonexistent. In this work, a series of in vitro and in vivo experiments were performed to dissect the relationship between allopurinol, allopurinol metabolites, and colonic epithelial metabolism and function in health and during disease. Of particular significance, the in vivo investigation identified that a therapeutically relevant allopurinol dose shifts adenylate and creatine metabolism, leading to AMPK dysregulation and disrupted proliferation to attenuate wound healing and increased tissue damage in murine experimental colitis. Collectively, these findings underscore the importance of purine salvage on cellular metabolism and gut health in the context of IBD and provide insight regarding the use of allopurinol in patients with IBD.
Collapse
Affiliation(s)
- Corey S. Worledge
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.S.W.); (R.E.K.); (L.Z.); (G.B.); (S.P.C.)
| | - Rachael E. Kostelecky
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.S.W.); (R.E.K.); (L.Z.); (G.B.); (S.P.C.)
| | - Liheng Zhou
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.S.W.); (R.E.K.); (L.Z.); (G.B.); (S.P.C.)
| | - Geetha Bhagavatula
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.S.W.); (R.E.K.); (L.Z.); (G.B.); (S.P.C.)
| | - Sean P. Colgan
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.S.W.); (R.E.K.); (L.Z.); (G.B.); (S.P.C.)
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
| | - J. Scott Lee
- Mucosal Inflammation Program, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (C.S.W.); (R.E.K.); (L.Z.); (G.B.); (S.P.C.)
| |
Collapse
|
14
|
Barone T, Dandekar S, McKeone D, Mulieri K. Assessment on the use of allopurinol to improve safety and efficacy of mercaptopurine in pediatric patients with Acute Lymphoblastic Leukemia and Lymphoma during maintenance therapy. Cancer Rep (Hoboken) 2024; 7:e1987. [PMID: 38351548 PMCID: PMC10864713 DOI: 10.1002/cnr2.1987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Mercaptopurine is an important component of acute lymphoblastic leukemia (ALL) and lymphoma (LLy) maintenance therapy. The 6-thioguanine nucleosides (6-TGN) are believed to be the primary contributor to myelosuppression and immunosuppressive effects, while 6-methylmercaptopurine (6-MMPN) is believed to be responsible for several toxicities including hepatotoxicity, pancreatitis, and hypoglycemia. Previous reports suggest the addition of allopurinol may reduce these toxicities. AIMS To assess the use of allopurinol to improve both safety and efficacy of mercaptopurine in pediatric patients with ALL and LLy during maintenance therapy. Secondary objectives included evaluating patient tolerability and skewed metabolism. In addition, we also analyzed mercaptopurine daily dose reduction upon allopurinol initiation. METHODS AND RESULTS The primary endpoint was time within goal ANC prior to and after initiation of allopurinol. Secondary endpoints included; improvement in selective toxicities (hepatotoxicity, pancreatitis, and hypoglycemia) and 6-MMPN to 6-TGN ratio prior to and after allopurinol initiation. In addition, an exploratory endpoint assessing mercaptopurine daily dose reduction prior to and after allopurinol initiation was included. Sixteen patients met inclusion criteria and 15 (94%) of which were included in this study. Median percent of maintenance days within goal ANC prior to and after initiation of allopurinol was 27.8 (IQR 22.6-44.9) and 41.6 (IQR 20.2-58.2) respectively. All patients experienced selective toxicities; 15 (100%) hepatotoxicity, 1 (7%) pancreatitis, and 3 (20%) hypoglycemia. Improvement of toxicities was seen in 13/15 (87%), 1/1 (100%), and 2/3 (67%) respectively. Average 6-MMPN:6-TGN ratio prior to allopurinol initiation was 304:1 and after, allopurinol initiation improved to 15:1, resulting in a 95% reduction. Average mercaptopurine dose prior to and after allopurinol initiation decreased by about 56% (63 to 28 mg/m2 /day). CONCLUSION Results suggest that the use of allopurinol in pediatric patients with ALL and LLy receiving mercaptopurine during maintenance therapy is both safe and effective.
Collapse
Affiliation(s)
- Tecca Barone
- Department of PharmacyPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Smita Dandekar
- Division of Pediatric Hematology/OncologyPenn State Children's HospitalHersheyPennsylvaniaUSA
| | - Daniel McKeone
- Division of Pediatric Hematology/OncologyPenn State Children's HospitalHersheyPennsylvaniaUSA
| | - Kevin Mulieri
- Department of PharmacyPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| |
Collapse
|
15
|
Emad Y, Dalbeth N, Weinman J, Chalder T, Petrie KJ. Can Smartphone Notifications Help With Gout Management? A Feasibility Study. J Rheumatol 2024; 51:189-196. [PMID: 37967906 DOI: 10.3899/jrheum.2023-0711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE This feasibility study aimed to assess the acceptability of using smartphone notifications to modify the medication beliefs of people with gout. We evaluated the feasibility and acceptability of a smartphone application using the Technology Acceptance Model. We explored adherence rate differences and outcomes between the intervention and control groups. METHODS Fifty-two patients with gout who were prescribed allopurinol were randomly assigned to either active control (n = 24) or intervention group (n = 28). Over 3 months, both groups used the study app on their smartphones. The active control group received notifications about general health advice, whereas the intervention group received adherence-targeted notifications. The feasibility and acceptability of the smartphone app was measured through semistructured interviews. Adherence rate was assessed through serum urate levels and missed doses at 3 timepoints: baseline, 3 months (post intervention), and 6 months (follow-up). RESULTS The smartphone app demonstrated high feasibility, with strong participant retention and compliance. The participants expressed high levels of satisfaction with the app's user-friendliness and content, highlighting its acceptability. Both groups showed a significant reduction in missed doses over time (P < 0.05), but no significant differences in serum urate levels were found between the groups. Patients who received adherence-targeted notifications reported finding it more convenient to take allopurinol and expressed higher overall treatment satisfaction throughout the study. CONCLUSION Adherence-targeted notifications have the potential to be an effective and scalable approach to supporting medication adherence in patients with gout. Further research is needed with larger samples to refine the components of the intervention and explore its optimal implementation.
Collapse
Affiliation(s)
- Yasaman Emad
- Y. Emad, MA, K.J. Petrie, PhD, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand;
| | - Nicola Dalbeth
- N. Dalbeth, MD, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - John Weinman
- J. Weinman, PhD, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Trudie Chalder
- T. Chalder, PhD, School of Psychology, King's College London, London, UK
| | - Keith J Petrie
- Y. Emad, MA, K.J. Petrie, PhD, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
16
|
Congcong F, Xiaoliang Z, Yongjian Z, Huan QI, Yingjie Z. Combination of allopurinol with Dahuang Mudan Tang significantly improve kidney function and alleviate oxidative stress and inflammation of chronic kidney disease stage Ⅰ-Ⅲ patients with hyperuricemia. J TRADIT CHIN MED 2024; 44:182-187. [PMID: 38213253 PMCID: PMC10774714 DOI: 10.19852/j.cnki.jtcm.20231121.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/06/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To evaluate the effect of Dahuang Mudan Tang (, DHMD) and allopurinol on the treatment of chronic kidney disease staged G1-G3b patients with hyperuricemia and to provide novel insights into the clinical management of chronic kidney disease complications. METHODS A total of 80 chronic kidney patients staged G1-G3b with hyperuricemia were randomly grouped to receive single allopurinol treatment (control) and combined treatment with DHMD (treated) for 8 weeks. The kidney function and proteinuria indicators of patients were compared between pre-and post-treatment. The oxidative stress and inflammation responses were evaluated by corresponding indicators and cytokines. The clinical efficiency rate and adverse reaction events were also summarized to assess the therapeutic efficiency and safety. RESULTS The kidney function and proteinuria of enrolled patients were alleviated after their therapies, behaved as the increasing estimated glomerular filtration rate and decreasing serum creatinine, serum uric acid, urea nitrogen, 24 h urine protein levels. On the other hand, the malondialdehyde level and pro-inflammation cytokines were suppressed by the therapies, and the superoxide dismutase was found to be significantly enhanced. Patients in the treated groups showed a better recovery in kidney function, proteinuria, oxidative stress, and inflammation response. Moreover, patients in the treated group showed a higher efficiency rate (95%) and fewer adverse reaction events (5%). CONCLUSIONS The combination of allopurinol with DHMD significantly promoted the recovery of chronic kidney disease stage G1-G3b patients with hyperuricemia, which can be considered a novel clinical therapeutic strategy.
Collapse
Affiliation(s)
- Fang Congcong
- Department of Endocrinology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
- Department of Nephrology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
| | - Zhu Xiaoliang
- Department of Endocrinology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
| | - Zhang Yongjian
- Department of Endocrinology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
| | - Q I Huan
- Department of Nephrology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
| | - Zhang Yingjie
- Department of Nephrology, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China
| |
Collapse
|
17
|
Sanchez C, Campeau A, Liu-Bryan R, Mikuls T, O'Dell J, Gonzalez D, Terkeltaub R. Sustained xanthine oxidase inhibitor treat to target urate lowering therapy rewires a tight inflammation serum protein interactome. Res Sq 2024:rs.3.rs-3770277. [PMID: 38260556 PMCID: PMC10802734 DOI: 10.21203/rs.3.rs-3770277/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Effective xanthine oxidoreductase inhibition (XOI) urate-lowering treatment (ULT) to target significantly reduces gout flare burden and synovitis between 1-2 years therapy, without clearing all monosodium urate crystal deposits. Paradoxically, treat to target ULT is associated with increased flare activity for at least 1 year in duration on average, before gout flare burden decreases. Since XOI has anti-inflammatory effects, we tested for biomarkers of sustained, effective ULT that alters gouty inflammation. Methods We characterized the proteome of febuxostat-treated murine bone marrow macrophages. Blood samples (baseline and 48 weeks ULT) were analyzed by unbiased proteomics in febuxostat and allopurinol ULT responders from two, independent, racially and ethnically distinct comparative effectiveness trial cohorts (n=19, n=30). STRING-db and multivariate analyses supplemented determinations of significantly altered proteins via Wilcoxon matched pairs signed rank testing. Results The proteome of cultured IL-1b-stimulated macrophages revealed febuxostat-induced anti-inflammatory changes, including for classical and alternative pathway complement activation pathways. At 48 weeks ULT, with altered purine metabolism confirmed by serum metabolomics, serum urate dropped >30%, to normal (<6.8 mg/dL) in all the studied patients. Overall, flares declined from baseline. Treated gout patient sera and peripheral blood mononuclear cells (PBMCs) showed significantly altered proteins (p<0.05) in clustering and proteome networks. CRP was not a useful therapy response biomarker. By comparison, significant serum proteome changes included decreased complement C8 heterotrimer C8A and C8G chains essential for C5b-9 membrane attack complex assembly and function; increase in the NLRP3 inflammasome activation promoter vimentin; increased urate crystal phagocytosis inhibitor sCD44; increased gouty inflammation pro-resolving mediator TGFB1; decreased phagocyte-recruiting chemokine PPBP/CXCL7, and increased monocyte/macrophage-expressed keratin-related proteins (KRT9,14,16) further validated by PBMC proteomics. STRING-db analyses of significantly altered serum proteins from both cohorts revealed a tight interactome network including central mediators of gouty inflammation (eg, IL-1B, CXCL8, IL6, C5). Conclusions Rewiring of inflammation mediators in a tight serum protein interactome was a biomarker of sustained XOI-based ULT that effectively reduced serum urate and gout flares. Monitoring of the serum and PBMC proteome, including for changes in the complement pathway could help determine onset and targets of anti-inflammatory changes in response to effective, sustained XOI-based ULT.Trial Registration: ClinicalTrials.gov Identifier: NCT02579096.
Collapse
|
18
|
Fabian IM, Maddox K, Robicheaux C, Islam RK, Anwar A, Dorius B, Robinson CL, Kaye AM, Varrassi G, Ahmadzadeh S, Shekoohi S, Kaye AD. Stevens-Johnson Syndrome From Combined Allopurinol and Angiotensin-Converting Enzyme Inhibitors: A Narrative Review. Cureus 2024; 16:e51899. [PMID: 38333456 PMCID: PMC10850002 DOI: 10.7759/cureus.51899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Stevens-Johnson syndrome (SJS) is a severe and potentially debilitating skin reaction frequently related to medication use. Allopurinol and angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed medications for prevalent health conditions worldwide, and their interaction associated with SJS warrants further investigation. A comprehensive literature search was performed to investigate cases as studies related to SJS occurring in patients with concomitant use of allopurinol and ACE inhibitors. We identified case reports and studies detailing hypersensitivity reactions, including SJS, attributed to a combination of allopurinol and ACE inhibitors. Despite the drug-drug interactions or lack thereof seen in patient populations, there is no definitive evidence of a pharmacokinetic interaction between allopurinol and ACE inhibitors. We were only able to find one case report specifically detailing SJS in a patient on combined ACE inhibitors and allopurinol. While the exact mechanism of the interaction is unclear, those reported cases of severe hypersensitivity reactions suggest a previous history of impaired renal function as a predisposing factor in the development of SJS. The potential risk of SJS with coadministration of ACE inhibitors and allopurinol is a drug-drug interaction that physicians should be aware of. This topic requires additional attention to determine if this drug combination should be avoided entirely in certain patients.
Collapse
Affiliation(s)
- Isabella M Fabian
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Kirsten Maddox
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Cameron Robicheaux
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Rahib K Islam
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Ahmed Anwar
- Department of Psychology, Quinnipiac University, Hamden, USA
| | - Bradley Dorius
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences University of the Pacific, Stockton, USA
| | | | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| |
Collapse
|
19
|
Perdigão S, Alves AS, Nunes M, Sousa C, Barros N. Allopurinol-Induced Toxic Epidermal Necrolysis. Cureus 2024; 16:e52222. [PMID: 38347997 PMCID: PMC10861211 DOI: 10.7759/cureus.52222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
Toxic epidermal necrolysis (TEN) is a rare and life-threatening cutaneous disease, frequently triggered by drugs. Allopurinol is one of the most frequent drugs associated with TEN, which implies detachment of a significant amount of the body surface area (BSA) and has a high morbidity and mortality associated with it. We present the case of a 68-year-old female with a recent diagnosis of hyperuricemia who started treatment with allopurinol. A week later, she presented to the emergency department with an extensive maculopapular exanthema with blisters and skin detachment. After the exclusion of other etiologies, the diagnosis of allopurinol-induced TEN was made, with 35% of BSA involvement. Due to the severity of the clinical condition, she was admitted to intensive care and treated with corticoids that had no response. So, she was started on immunoglobulins and transferred to a burn unit. She developed sepsis with multiorgan failure and required supportive treatment. She was discharged after a month, and physical rehabilitation was needed. This clinical case highlights the severity of allopurinol hypersensitivity that may happen and the importance of an accurate diagnosis and treatment for this rare disease.
Collapse
Affiliation(s)
- Sofia Perdigão
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro (Hospital Center of Trás-os-Montes and Alto Douro), Chaves, PRT
| | - Ana Sofia Alves
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro (Hospital Center of Trás-os-Montes and Alto Douro), Chaves, PRT
| | - Mariana Nunes
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro (Hospital Center of Trás-os-Montes and Alto Douro), Chaves, PRT
| | - Cristiana Sousa
- Internal Medicine, Centro Hospitalar de Trás-os-Montes e Alto Douro (Hospital Center of Trás-os-Montes and Alto Douro), Chaves, PRT
| | - Nelson Barros
- Intensive Care Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro (Hospital Center of Trás-os-Montes and Alto Douro), Vila Real, PRT
| |
Collapse
|
20
|
Setoyama A, Sawada Y. Drug-Induced Hypersensitivity Syndrome Accompanied With Acute Renal Failure With Hemodialysis: A Case Report and Literature Review. Cureus 2024; 16:e52335. [PMID: 38361726 PMCID: PMC10867719 DOI: 10.7759/cureus.52335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Drug-induced hypersensitivity syndrome (DIHS) is a severe type of cutaneous adverse event involving systemic organ failures. In some cases of DIHS, acute renal failure takes place, and it becomes necessary to perform hemodialysis. However, the clinical outcome of renal failure in the course of treatment of DIHS remains unclear. Herein, we report a case of DIHS complicated with acute renal failure, which requires hemodialysis. Furthermore, we also review the DIHS cases accompanied by acute renal failure with hemodialysis in the English case report literature.
Collapse
Affiliation(s)
- Ayako Setoyama
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Yu Sawada
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| |
Collapse
|
21
|
Fayed A, Hammad AA, Abdulazim DO, Hammad H, Amin M, Elhadidy S, Salem MM, ElAzim IMA, Zsom L, Csongradi E, Soliman KM, Sharaf El Din UA. Is the combination of linagliptin and allopurinol better prophylaxis against post-contrast acute kidney injury? A multicenter prospective randomized controlled study. Ren Fail 2023; 45:2194434. [PMID: 36974638 PMCID: PMC10054158 DOI: 10.1080/0886022x.2023.2194434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Patients with diabetic kidney disease (DKD) are at increased risk to develop post-contrast acute kidney injury (AKI). Diabetic patients under dipeptidyl peptidase 4 inhibitors (DPP4Is) experience a lower propensity to develop AKI. We speculated that linagliptin as a single agent or in combination with allopurinol may reduce the incidence of post-contrast AKI in stage 3-5 chronic kidney disease (CKD) patients with underlying DKD. METHODS Out of 951 DKD patients eligible for this study, 800 accepted to sign informed consent. They were randomly allocated to 4 equal groups that received their prophylaxis for 2 days before and after radiocontrast. The first control group received N-acetyl cysteine and saline, the 2nd received allopurinol, the 3rd group received linagliptin, and the 4th received both allopurinol and linagliptin. Post-procedure follow-up for kidney functions was conducted for 2 weeks in all patients. RESULTS 20, 19, 14, and 8 patients developed post-contrast AKI in groups 1 through 4, respectively. Neither linagliptin nor allopurinol was superior to N-acetyl cysteine and saline alone. However, the combination of the two agents provided statistically significant renal protection: post-contrast AKI in group 4 was significantly lower than in groups 1 and 2 (p < 0.02 and <0.03, respectively). None of the post-contrast AKI cases required dialysis. CONCLUSION Linagliptin and allopurinol in combination may offer protection against post-contrast AKI in DKD exposed to radiocontrast. Further studies are needed to support this view. TRIAL REGISTRATION CLINICALTRIALS.GOV NCT03470454.
Collapse
Affiliation(s)
- Ahmed Fayed
- Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | - Ahmed A Hammad
- Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Dina O Abdulazim
- Rheumatology and Rehabilitation Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | - Hany Hammad
- Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Amin
- Critical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | - Samir Elhadidy
- Critical Care Medicine Department, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | - Mona M Salem
- Endocrinology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | | | - Lajos Zsom
- Fresenius Medical Care Hungary, Cegléd, Hungary
| | - Eva Csongradi
- Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Karim M Soliman
- Department of Surgery, Division of Transplant, Medical University of South Carolina, Charleston, SC, USA
| | - Usama A Sharaf El Din
- Nephrology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| |
Collapse
|
22
|
Martínez JD, Franco R, Sáenz LM, Alvarado AG, García JA, Delgado SM, Ionescu MA, Busilă C, Tatu AL. DRESS and Stevens-Johnson Syndrome Overlap Secondary to Allopurinol in a 50-Year-Old Man-A Diagnostic and Treatment Challenge: Case Report. Life (Basel) 2023; 13:2251. [PMID: 38137852 PMCID: PMC10744808 DOI: 10.3390/life13122251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug reaction commonly related to eosinophilia, from uncertain epidemiology, and without consensus for diagnosis and treatment globally. It presents a great challenge in its management and is characterized by fever, lymphadenopathy, skin rash, and multisystemic involvement. An aggressive and difficult-to-manage clinical case is presented in a 50-year-old man with chronic kidney disease due to diabetes mellitus type 2 and systemic arterial hypertension, who developed an unusual variant similar to DRESS and Stevens-Johnson syndrome (SJS) overlap secondary to allopurinol, with skin manifestations without eosinophilia, but fulfilling clinical and laboratory criteria for DRESS and SJS syndrome.
Collapse
Affiliation(s)
- José Dario Martínez
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico;
| | - Rodolfo Franco
- Department of Human Pathology, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (R.F.); (J.A.G.)
| | - Luis Manuel Sáenz
- Faculty of Medicine, University Hospital José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (L.M.S.); (S.M.D.)
| | - Americo Guadalupe Alvarado
- Department of Internal Medicine, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico;
| | - José Antonio García
- Department of Human Pathology, Faculty of Medicine, Hospital Universitario José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (R.F.); (J.A.G.)
| | - Sergio Máximo Delgado
- Faculty of Medicine, University Hospital José Eleuterio González, University Autonomous of Nuevo León, Monterrey 66455, Mexico; (L.M.S.); (S.M.D.)
| | - Marius-Anton Ionescu
- Department of Dermatology, University Hospital Saint Louis, 63110 Paris, France;
| | - Camelia Busilă
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania;
| | - Alin Laurentiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania;
- Dermatology Department, “Sfanta Cuvioasa Paraschiva” Hospital of Infectious Diseases, 800179 Galati, Romania
| |
Collapse
|
23
|
Al-Shargi A, El Kholy AA, Adel A, Hassany M, Shaheen SM. Allopurinol versus Febuxostat: A New Approach for the Management of Hepatic Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease. Biomedicines 2023; 11:3074. [PMID: 38002074 PMCID: PMC10669273 DOI: 10.3390/biomedicines11113074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) includes patients with hepatic steatosis and at least one of five cardiometabolic risk factors. Xanthine oxidase (XO) represents a treatment target for MASLD. We aimed to evaluate the effect of two xanthine oxidase inhibitors, allopurinol and febuxostat, plus lifestyle modifications compared to lifestyle modifications alone on improving steatosis. Ninety MASLD patients were assigned to one of three groups for three months. Patients with hyperuricemia were given either allopurinol 100 mg or febuxostat 40 mg daily, along with lifestyle modifications. The third control group was only given lifestyle modifications, excluding all patients with hyperuricemia due to ethical concerns. The primary outcome was to measure the change in the controlled attenuation parameter (CAP) score as an indicator of steatosis from baseline after three months. The secondary outcome was to measure the change in serum uric acid (SUA) three months from baseline. The study found that the CAP score decreased significantly in the allopurinol group (p = 0.009), but the decline in the febuxostat or lifestyle groups was non-significant (p = 0.189 and 0.054, respectively). The SUA levels were significantly reduced in both the allopurinol and febuxostat groups (p < 0.001), with no statistical difference between the two groups (p = 0.496).
Collapse
Affiliation(s)
- Amani Al-Shargi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 4393005, Egypt; (A.A.E.K.); (S.M.S.)
| | - Amal A. El Kholy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 4393005, Egypt; (A.A.E.K.); (S.M.S.)
| | - Abdulmoneim Adel
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo 4260010, Egypt; (A.A.); (M.H.)
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo 4260010, Egypt; (A.A.); (M.H.)
| | - Sara M. Shaheen
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo 4393005, Egypt; (A.A.E.K.); (S.M.S.)
| |
Collapse
|
24
|
Mifsud NA, Illing PT, Ho R, Tuomisto JE, Fettke H, Mullan KA, McCluskey J, Rossjohn J, Vivian J, Reantragoon R, Purcell AW. The allopurinol metabolite, oxypurinol, drives oligoclonal expansions of drug-reactive T cells in resolved hypersensitivity cases and drug-naïve healthy donors. Allergy 2023; 78:2980-2993. [PMID: 37452515 PMCID: PMC10952278 DOI: 10.1111/all.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/18/2023]
Abstract
Allopurinol (ALP) is a successful drug used in the treatment of gout. However, this drug has been implicated in hypersensitivity reactions that can cause severe to life-threatening reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Individuals who carry the human leukocyte antigen (HLA)-B*58:01 allotype are at higher risk of experiencing a hypersensitivity reaction (odds ratios ranging from 5.62 to 580.3 for mild to severe reactions, respectively). In addition to the parent drug, the metabolite oxypurinol (OXP) is implicated in triggering T cell-mediated immunopathology via a labile interaction with HLA-B*58:01. To date, there has been limited information regarding the T-cell receptor (TCR) repertoire usage of reactive T cells in patients with ALP-induced SJS or TEN and, in particular, there are no reports examining paired αβTCRs. Here, using in vitro drug-treated PBMCs isolated from both resolved ALP-induced SJS/TEN cases and drug-naïve healthy donors, we show that OXP is the driver of CD8+ T cell-mediated responses and that drug-exposed memory T cells can exhibit a proinflammatory immunophenotype similar to T cells described during active disease. Furthermore, this response supported the pharmacological interaction with immune receptors (p-i) concept by showcasing (i) the labile metabolite interaction with peptide/HLA complexes, (ii) immunogenic complex formation at the cell surface, and (iii) lack of requirement for antigen processing to elicit drug-induced T cell responsiveness. Examination of paired OXP-induced αβTCR repertoires highlighted an oligoclonal and private clonotypic profile in both resolved ALP-induced SJS/TEN cases and drug-naïve healthy donors.
Collapse
Affiliation(s)
- Nicole A. Mifsud
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Patricia T. Illing
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Rebecca Ho
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Johanna E. Tuomisto
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| | - Heidi Fettke
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
- Present address:
Cancer Research, Peter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Present address:
Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Kerry A. Mullan
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
- Present address:
ADREM Data Lab, Department of Computer ScienceUniversity of AntwerpAntwerpBelgium
| | - James McCluskey
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and ImmunityUniversity of MelbourneParkvilleVictoriaAustralia
| | - Jamie Rossjohn
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
- Institute of Infection and ImmunityCardiff University School of MedicineCardiffUK
| | - Julian Vivian
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
- Present address:
St. Vincent's Institute of Medical ResearchFitzroyVictoriaAustralia
- Present address:
Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Rangsima Reantragoon
- Immunology Division, Department of Microbiology, Department of MicrobiologyChulalongkorn UniversityBangkokThailand
- Center of Excellence in Immunology and Immune‐mediated Disease, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Anthony W. Purcell
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery InstituteMonash UniversityClaytonVictoriaAustralia
| |
Collapse
|
25
|
Agrawal N, Arya M, Kushwah P. Therapeutic voyage of synthetic and natural xanthine oxidase inhibitors. Chem Biol Drug Des 2023; 102:1293-1307. [PMID: 37550063 DOI: 10.1111/cbdd.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
Xanthine oxidase (XO) inhibitors are commonly used to treat gout, nephropathy, and renal stone diseases related to hyperuricemia. However, recent research has shown that these inhibitors may also have potential benefits in preventing vascular diseases, including those affecting the cerebrovasculature. This is due to emerging evidence suggesting that serum uric acid is involved in the growth of cardiovascular disease, and XO inhibition can reduce oxidative stress in the vasculature. There is a great interest in the development of new XO inhibitors for the treatment of hyperuricemia and gout. The present review discusses the many synthetic and natural XO inhibitors that have been developed which are found to have greater potency.
Collapse
Affiliation(s)
- Neetu Agrawal
- Institute of Pharmaceutical Research, GLA University, Mathura, India
| | - Medha Arya
- Institute of Pharmaceutical Research, GLA University, Mathura, India
| | - Priya Kushwah
- Institute of Pharmaceutical Research, GLA University, Mathura, India
| |
Collapse
|
26
|
Russell MD, Ameyaw-Kyeremeh L, Dell'Accio F, Lapham H, Head N, Stovin C, Patel V, Clarke BD, Nagra D, Alveyn E, Adas MA, Bechman K, de la Puente MA, Ellis B, Byrne C, Patel R, Rutherford AI, Cantle F, Norton S, Roddy E, Hudson J, Cope AP, Galloway JB. Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares. Rheumatology (Oxford) 2023:kead574. [PMID: 37929968 DOI: 10.1093/rheumatology/kead574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/25/2023] [Accepted: 08/13/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES To evaluate a strategy designed to optimise care and increase uptake of urate-lowering therapy (ULT) during hospitalisations for gout flares. METHODS We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment, and re-hospitalisation rates, were compared between patients hospitalised for flares in the 12 months post-implementation and a retrospective cohort of hospitalised patients from 12 months pre-implementation. RESULTS 119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n = 94 and n = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio (aOR) 11.5; 95% confidence interval (CI) 4.36-30.5; p < 0.001). After implementation, more patients achieved a serum urate ≤360 micromol/L within 6 months of discharge (10.6% pre-implementation vs. 26.8% post-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients re-hospitalised for flares was 14.9% pre-implementation vs. 9.3% post-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18). CONCLUSION Over 90% of patients were initiated on ULT after implementing a strategy to optimise hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalisations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalised gout patients to achieve urate targets, closer primary-secondary care integration is still needed.
Collapse
Affiliation(s)
- Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Louise Ameyaw-Kyeremeh
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Flora Dell'Accio
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Heather Lapham
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Natalie Head
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Christopher Stovin
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Vishit Patel
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Benjamin D Clarke
- Benjamin Clarke, Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Deepak Nagra
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Edward Alveyn
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Maryam A Adas
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Katie Bechman
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - María A de la Puente
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, United Kingdom
| | - Benjamin Ellis
- Department of Rheumatology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Corrine Byrne
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Rina Patel
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Andrew I Rutherford
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Fleur Cantle
- Department of Emergency Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sam Norton
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - Edward Roddy
- School of Medicine, Keele University, Keele, United Kingdom
| | - Joanna Hudson
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Andrew P Cope
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| | - James B Galloway
- Centre for Rheumatic Diseases, King's College London, London, United Kingdom
| |
Collapse
|
27
|
Comparison table: Some drugs for gout. Med Lett Drugs Ther 2023; 65:e176-9. [PMID: 37871112 DOI: 10.58347/tml.2023.1688c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
|
28
|
Drugs for gout. Med Lett Drugs Ther 2023; 65:169-75. [PMID: 37871110 DOI: 10.58347/tml.2023.1688a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
|
29
|
Anis TR, Meher J. Allopurinol-Induced Stevens-Johnson Syndrome (SJS). Clin Pharmacol 2023; 15:99-105. [PMID: 37811521 PMCID: PMC10557962 DOI: 10.2147/cpaa.s427714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Allopurinol is a commonly used medication that lowers uric acid production which is essential for gout treatment and prevention. Although many patients tolerate allopurinol therapy without severe complications; Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening delayed hypersensitivity reactions that have been reported especially among Asian and African American patients. We describe a case of allopurinol-induced SJS in a 95-year-old Asian female. The patient started allopurinol 13 days prior to presenting to the emergency room (ER). On day 10 of therapy, the patient developed a diffuse erythematous desquamating rash which prompted her to visit the ER after 3 days from the rash onset. This case report describes a rare fatal hypersensitivity reaction that requires rapid identification and treatment in a multi-disciplinary setting.
Collapse
Affiliation(s)
- Takla R Anis
- Pharmacy Department, Henry Mayo Newhall Hospital, Valencia, CA, USA
| | - John Meher
- Emergency Department, Henry Mayo Newhall Hospital, Valencia, CA, USA
| |
Collapse
|
30
|
Wen YF, Brundage RC, Roman YM, Culhane-Pera KA, Straka RJ. Population pharmacokinetics, pharmacodynamics and pharmacogenetics modelling of oxypurinol in Hmong adults with gout and/or hyperuricemia. Br J Clin Pharmacol 2023; 89:2964-2976. [PMID: 37202871 PMCID: PMC10527451 DOI: 10.1111/bcp.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
AIMS The aim of this study was to quantify identifiable sources of variability, including key pharmacogenetic variants in oxypurinol pharmacokinetics and their pharmacodynamic effect on serum urate (SU). METHODS Hmong participants (n = 34) received 100 mg allopurinol twice daily for 7 days followed by 150 mg allopurinol twice daily for 7 days. A sequential population pharmacokinetic pharmacodynamics (PKPD) analysis with non-linear mixed effects modelling was performed. Allopurinol maintenance dose to achieve target SU was simulated based on the final PKPD model. RESULTS A one-compartment model with first-order absorption and elimination best described the oxypurinol concentration-time data. Inhibition of SU by oxypurinol was described with a direct inhibitory Emax model using steady-state oxypurinol concentrations. Fat-free body mass, estimated creatinine clearance and SLC22A12 rs505802 genotype (0.32 per T allele, 95% CI 0.13, 0.55) were found to predict differences in oxypurinol clearance. Oxypurinol concentration required to inhibit 50% of xanthine dehydrogenase activity was affected by PDZK1 rs12129861 genotype (-0.27 per A allele, 95% CI -0.38, -0.13). Most individuals with both PDZK1 rs12129861 AA and SLC22A12 rs505802 CC genotypes achieve target SU (with at least 75% success rate) with allopurinol below the maximum dose, regardless of renal function and body mass. In contrast, individuals with both PDZK1 rs12129861 GG and SLC22A12 rs505802 TT genotypes would require more than the maximum dose, thus requiring selection of alternative medications. CONCLUSIONS The proposed allopurinol dosing guide uses individuals' fat-free mass, renal function and SLC22A12 rs505802 and PDZK1 rs12129861 genotypes to achieve target SU.
Collapse
Affiliation(s)
- Ya-Feng Wen
- Department of Experimental and Clinical Pharmacology,
College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Richard C. Brundage
- Department of Experimental and Clinical Pharmacology,
College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Youssef M. Roman
- Department of Pharmacotherapy & Outcomes Science,
School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | | - Robert J. Straka
- Department of Experimental and Clinical Pharmacology,
College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| |
Collapse
|
31
|
Bai Y, Wu B, Gou L, Fang Z, Xu T, Zhang T, Li Y. Cardiovascular Safety Evaluation of Febuxostat and Allopurinol: Findings from the FDA Adverse Event Reporting System. J Clin Med 2023; 12:6089. [PMID: 37763029 PMCID: PMC10531992 DOI: 10.3390/jcm12186089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Febuxostat and allopurinol are the most commonly used uric acid-lowering medications, and their safety is of great concern, especially the cardiovascular adverse reactions associated with febuxostat. We propose to study the cardiovascular toxicity of febuxostat and allopurinol using the FDA Adverse Event Reporting System (FAERS) database. METHODS A total of 64 quarters of FAERS data were downloaded from 2004 to 2019. Febuxostat- and allopurinol-related cardiovascular adverse events were extracted after data cleaning. Signal detection was conducted by reporting odds ratio (ROR) and proportional reporting ratio (PRR). RESULTS There were 2939 and 25,219 reports of febuxostat- and allopurinol-related cardiovascular adverse events (CVAEs), respectively. The most frequent CVAEs with febuxostat and allopurinol were edema peripheral (14.38%) and peripheral swelling (8.76%), respectively. In elderly gout patients, febuxostat is associated with an increased risk of heart failure, ischemic heart disease, hypertension, and cardiomyopathy. Febuxostat in combination with acetic acid derivatives nonsteroidal anti-inflammatory drug (NSAIDS) also increases the risk of cardiovascular adverse events. CONCLUSIONS Compared with allopurinol, febuxostat may increase cardiovascular toxicity in patients with gout.
Collapse
Affiliation(s)
- Yang Bai
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Liangwen Gou
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Zhenwei Fang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| | - Tiejun Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuwen Li
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.B.); (B.W.); (T.X.)
| |
Collapse
|
32
|
Dewi C, Puspita F, Puspitasari IM, Zakiyah N. Hepatic Safety of Febuxostat and Allopurinol for Gout Patients: A Systematic Review of Randomized Controlled Trial. Ther Clin Risk Manag 2023; 19:731-743. [PMID: 37744559 PMCID: PMC10516211 DOI: 10.2147/tcrm.s424598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose This study aims to systematically review the hepatic safety of febuxostat and allopurinol in adult gout patients. Methods We searched for information using the following databases: PubMed, Cochrane Library, and Scopus. The inclusion criteria were to review all randomized controlled trials (RCT) that compared allopurinol and febuxostat for adult gout patients that had an assessment of liver function outcomes. Non-English studies on case reports, case series, reviews, and abstracts only were excluded. We extracted information from the studies to answer the research question, ie, study design, publication year, population, sample size, patient characterization, duration, Jadad score, and liver function outcomes. Results We screened 512 publications from the databases and identified 11 studies that met the inclusion criteria. Ten out of 11 included studies were double-blind RCTs. In the majority of the included studies, no statistically significant differences were observed in terms of hepatic safety data between febuxostat and allopurinol. However, in studies where allopurinol titration was used, it posed a challenge to maintain blinding. Notably, consistent adverse events related to liver function findings were observed across all reviewed RCTs. These abnormal liver function test results sometimes led to study withdrawal based on the investigators' assessment. Nevertheless, the investigators classified most liver function test elevations as mild to moderate in severity. Conclusion Our analysis concluded that adult gout patients enrolled in the included RCTs exhibited similar hepatic safety profiles for both febuxostat and allopurinol treatment. Liver function abnormalities were identified in all RCTs included in this systematic review. Consequently, it is important for the product labeling information of both allopurinol and febuxostat to present and describe the current safety data to guide healthcare practitioners when prescribing these medications to patients. Pharmacovigilance and post-marketing pharmacoepidemiology data are essential in establishing the comprehensive safety profile.
Collapse
Affiliation(s)
- Christiyanti Dewi
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Falerina Puspita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Irma Melyani Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
33
|
Oka P, Chong WM, Ng DX, Aau WK, Tan NC. Epidemiology and risk factors associated with gout control among adult Asians: a real-world retrospective cohort study. Front Med (Lausanne) 2023; 10:1253839. [PMID: 37746085 PMCID: PMC10513174 DOI: 10.3389/fmed.2023.1253839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Gout is associated with significant morbidity and mortality, yet suboptimal gout control remains a problem globally. Identifying the risk factors associated with poor gout control among patients in primary care allows targeted interventions to improve their clinical management. This study aimed to determine the prevalence of poor gout control and its associated demographic and clinical factors among urbanized community-dwelling Asian patients. Methods This retrospective study was based on data extracted from the electronic medical records of 8 public primary care clinics in Singapore. Patients with a diagnostic code of gout who had 2 or more visits between 1st January 2018 and 31st December 2019 were included in the analysis. Data extracted included: demographics, anthropological measurements, comorbidities, serum uric acid levels and medication prescription. A patient is defined to have poor gout control if they suffer two or more acute gout attacks within a year. Chi-Squared test was used for categorical parameters. For continuous variables, univariate logistic regression analysis was first performed. Significant factors (p ≤ 0.1) were then included in the logistics regression model to account for confounders. Results A total of 7,970 patients and 24,624 visits were included in the analysis. The prevalence of poorly controlled gout was 28.2% (n = 2,244/7,970); only 46.3% of them (n = 1,039/2,244) were prescribed allopurinol and 13.4% (n = 301/2,244) were taking doses ≥300 mg. Using logistic regression, factors associated with poor gout control were: male gender [adjusted OR (AOR) =1.66, p < 0.001], Malay ethnicity (AOR = 1.27, p = 0.007), congestive heart failure (AOR = 1.64, p = 0.037). Patients prescribed allopurinol (AOR = 1.52, p < 0.001), NSAIDs (AOR = 2.76, p < 0.001) and corticosteroids (AOR = 2.83, p < 0.001) were more likely to have poorly-controlled gout. Conclusion Nearly 30% of patients had poor gout. Interventions should focus on male and Malay patients and those with congestive cardiac failure.
Collapse
Affiliation(s)
- Prawira Oka
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| |
Collapse
|
34
|
Ye Y, Liao G, Liu T, Hu X, Chen X, Bai L, Peng Y. Allopurinol for Secondary Prevention in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Cardiovasc Dev Dis 2023; 10:379. [PMID: 37754808 PMCID: PMC10532321 DOI: 10.3390/jcdd10090379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The effects of allopurinol in patients with cardiovascular disease are not well defined; therefore, the latest evidence is summarized in this study. METHODS PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) of allopurinol in patients with cardiovascular disease published up to 11 February 2023. The primary outcome was cardiovascular death. RESULTS We combined the results of 21 RCTs that included 22,806 patients. Compared to placebo/usual care, allopurinol treatment was not associated with a significant reduction in cardiovascular death (RR 0.60; 95% CI 0.33-1.11) or all-cause death (RR 0.90; 95% CI 0.72-1.12). However, evidence from earlier trials and studies with small sample sizes indicated that allopurinol might confer a protective effect in decreasing cardiovascular death (RR 0.34; 95% CI 0.15-0.76) across patients undergoing coronary artery bypass grafting (CABG) or having acute coronary syndrome (ACS). In comparisons between allopurinol and febuxostat, we observed no difference in cardiovascular death (RR 0.92; 95% CI 0.69-1.24) or all-cause death (RR 1.02; 95% CI 0.75-1.38). CONCLUSION Allopurinol could not reduce cardiovascular (CV) death or major adverse CV outcomes significantly in patients with existing cardiovascular diseases. Given the limitations of the original studies, the potential advantages of allopurinol observed in patients undergoing CABG or presenting with ACS necessitate further confirmation through subsequent RCTs. In the comparisons between allopurinol and febuxostat, our analysis failed to uncover any marked superiority of allopurinol in reducing the risk of adverse cardiovascular incidents.
Collapse
Affiliation(s)
- Yuyang Ye
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China; (Y.Y.); (G.L.); (T.L.); (X.C.); (L.B.)
| | - Guangzhi Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China; (Y.Y.); (G.L.); (T.L.); (X.C.); (L.B.)
| | - Ting Liu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China; (Y.Y.); (G.L.); (T.L.); (X.C.); (L.B.)
| | - Xinru Hu
- School of Medicine, Zhengzhou University, Zhengzhou 450052, China;
| | - Xuefeng Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China; (Y.Y.); (G.L.); (T.L.); (X.C.); (L.B.)
| | - Lin Bai
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China; (Y.Y.); (G.L.); (T.L.); (X.C.); (L.B.)
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China; (Y.Y.); (G.L.); (T.L.); (X.C.); (L.B.)
| |
Collapse
|
35
|
Zhou Z, Ryan J, Nelson MR, Woods RL, Orchard SG, Zhu C, Gilmartin-Thomas JFM, Fravel MA, Owen AJ, Murray AM, Espinoza SE, Ernst ME. The association of allopurinol with persistent physical disability and frailty in a large community based older cohort. J Am Geriatr Soc 2023; 71:2798-2809. [PMID: 37158186 PMCID: PMC10524392 DOI: 10.1111/jgs.18395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/12/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The protective effects of allopurinol on physical function in older adults are not well understood, despite its potential to improve functional gains and reduce sarcopenia. This study aims to determine the association between allopurinol, persistent physical disability, and frailty in older gout patients. METHODS This analysis used data from a randomized trial in an older cohort, ASPirin in Reducing Events in the Elderly (ASPREE). ASPREE recruited 19,114 participants aged ≥65 years without prior cardiovascular events, dementia, or independence-limiting physical disability at trial enrolment. This analysis examined the association of baseline and time-varying allopurinol use with persistent physical disability and new-onset frailty in participants with gout at baseline (self-report or use of any anti-gout medications). Frailty was measured using the Fried frailty phenotype (score ≥3/5) and a deficit accumulation frailty index (FI) (score >0.21/1.0). Multivariable Cox proportional-hazards models were used for main analyses. RESULTS This analysis included 1155 gout participants, with 630 taking allopurinol at baseline and 525 not. During a median follow-up of 5.7 years, 113 new allopurinol users were identified. Compared with nonusers, baseline allopurinol use was associated with a significant risk reduction of persistent physical disability (Adjusted HR 0.46, 95% CI 0.23-0.92, p = 0.03). The strength of the association was modestly attenuated in the time-varying analysis (Adjusted HR 0.56, 0.29-1.08, p = 0.08). No significant associations with frailty measures were observed for either baseline allopurinol use (Fried frailty: Adjusted HR 0.83, 0.62-1.12; FI: Adjusted HR 0.96, 0.74-1.24) or time-varying allopurinol use (Fried frailty: Adjusted HR 0.92, 0.69-1.24; FI: Adjusted HR 1.02, 0.78-1.33). CONCLUSIONS Allopurinol use in older adults with gout is associated with a reduced risk of persistent physical disability but not associated with risk of frailty.
Collapse
Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Julia F-M Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Institute for Health & Sport, Victoria University, VIC, Australia
- Australian Institute for Musculoskeletal Science, VIC, Australia
| | - Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
| | - Alice J. Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M. Murray
- Berman Center for Outcomes & Clinical Research, Hennepin HealthCare Research Institute, and Department of Medicine, Geriatrics Division, Hennepin Healthcare, Minneapolis, MN, USA
| | - Sara E. Espinoza
- University of Texas Health Science Center and Geriatric Research, Education & Clinical Center, San Antonio and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
| |
Collapse
|
36
|
So MW, Kim AR, Lee SG. Analysis of appropriate duration of colchicine prophylaxis to maximize the persistence of xanthine oxidase inhibitors as the first-line urate-lowering therapy in patients with gout using the Korean Health Insurance Review and Assessment Service database. Int J Rheum Dis 2023; 26:1770-1778. [PMID: 37431263 DOI: 10.1111/1756-185x.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION We investigated the appropriate duration of colchicine prophylaxis to maximize the persistence of xanthine oxidase inhibitors (XOIs) as first-line urate-lowering therapy (ULT) in patients with gout. This was a nationwide population-based retrospective cohort study using the Korean Health Insurance Review and Assessment database. METHODS Patients with gout aged ≥20 years who were newly initiated on XOIs, such as allopurinol or febuxostat, from July 2015 to June 2017 and received these medications for ≥6 months were analyzed and followed up until June 2019. Persistence of XOIs was compared according to the 6-month duration of colchicine prophylaxis. For additional subgroup analysis, we also compared the persistence of XOIs according to the 3-month duration of colchicine prophylaxis. RESULTS This study included 43 926 patients. The frequencies of patients with gout receiving colchicine prophylaxis for ≥6 months and ≥3 months were 6.3% and 7.6%, respectively. Allopurinol (65.2%) was prescribed more frequently than febuxostat (34.8%). During the study period, 23 475 patients (53.4%) stopped using XOIs. Colchicine prophylaxis for ≥6 months did not significantly reduce the risk of XOI discontinuation in multivariable Cox regression models. Colchicine prophylaxis for ≥3 months was significantly associated with a lower risk of non-persistence to XOIs after adjusting for confounding factors (hazard ratio = 0.95, p = .041). CONCLUSION Our data suggest that at least 3 months of colchicine prophylaxis may be more appropriate than at least 6 months in terms of maximizing the persistence of XOIs in patients with gout.
Collapse
Affiliation(s)
- Min Wook So
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - A-Ran Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Seung-Geun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| |
Collapse
|
37
|
Sekine M, Okamoto K, Pai EF, Nagata K, Ichida K, Hille R, Nishino T. Allopurinol and oxypurinol differ in their strength and mechanisms of inhibition of xanthine oxidoreductase. J Biol Chem 2023; 299:105189. [PMID: 37625592 PMCID: PMC10511816 DOI: 10.1016/j.jbc.2023.105189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023] Open
Abstract
Xanthine oxidoreductase is a metalloenzyme that catalyzes the final steps in purine metabolism by converting hypoxanthine to xanthine and then uric acid. Allopurinol, an analog of hypoxanthine, is widely used as an antigout drug, as xanthine oxidoreductase-mediated metabolism of allopurinol to oxypurinol leads to oxypurinol rotation in the enzyme active site and reduction of the molybdenum Mo(VI) active center to Mo(IV), inhibiting subsequent urate production. However, when oxypurinol is administered directly to a mouse model of hyperuricemia, it yields a weaker urate-lowering effect than allopurinol. To better understand its mechanism of inhibition and inform patient dosing strategies, we performed kinetic and structural analyses of the inhibitory activity of oxypurinol. Our results demonstrated that oxypurinol was less effective than allopurinol both in vivo and in vitro. We show that upon reoxidation to Mo(VI), oxypurinol binding is greatly weakened, and reduction by xanthine, hypoxanthine, or allopurinol is required for reformation of the inhibitor-enzyme complex. In addition, we show oxypurinol only weakly inhibits the conversion of hypoxanthine to xanthine and is therefore unlikely to affect the feedback inhibition of de novo purine synthesis. Furthermore, we observed weak allosteric inhibition of purine nucleoside phosphorylase by oxypurinol which has potentially adverse effects for patients. Considering these results, we propose the single-dose method currently used to treat hyperuricemia can result in unnecessarily high levels of allopurinol. While the short half-life of allopurinol in blood suggests that oxypurinol is responsible for enzyme inhibition, we anticipate multiple, smaller doses of allopurinol would reduce the total allopurinol patient load.
Collapse
Affiliation(s)
- Mai Sekine
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan.
| | - Ken Okamoto
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Emil F Pai
- Departments of Biochemistry and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Campbell Family Cancer Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Koji Nagata
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kimiyoshi Ichida
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, Japan
| | - Russ Hille
- Department of Biochemistry, University of California, Riverside, California, USA
| | - Takeshi Nishino
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| |
Collapse
|
38
|
Rodríguez-Rovira I, López-Sainz A, Palomo-Buitrago ME, Pérez B, Jiménez-Altayó F, Campuzano V, Egea G. Hyperuricaemia Does Not Interfere with Aortopathy in a Murine Model of Marfan Syndrome. Int J Mol Sci 2023; 24:11293. [PMID: 37511051 PMCID: PMC10379183 DOI: 10.3390/ijms241411293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Redox stress is involved in the aortic aneurysm pathogenesis in Marfan syndrome (MFS). We recently reported that allopurinol, a xanthine oxidoreductase inhibitor, blocked aortopathy in a MFS mouse model acting as an antioxidant without altering uric acid (UA) plasma levels. Hyperuricaemia is ambiguously associated with cardiovascular injuries as UA, having antioxidant or pro-oxidant properties depending on the concentration and accumulation site. We aimed to evaluate whether hyperuricaemia causes harm or relief in MFS aortopathy pathogenesis. Two-month-old male wild-type (WT) and MFS mice (Fbn1C1041G/+) were injected intraperitoneally for several weeks with potassium oxonate (PO), an inhibitor of uricase (an enzyme that catabolises UA to allantoin). Plasma UA and allantoin levels were measured via several techniques, aortic root diameter and cardiac parameters by ultrasonography, aortic wall structure by histopathology, and pNRF2 and 3-NT levels by immunofluorescence. PO induced a significant increase in UA in blood plasma both in WT and MFS mice, reaching a peak at three and four months of age but decaying at six months. Hyperuricaemic MFS mice showed no change in the characteristic aortic aneurysm progression or aortic wall disarray evidenced by large elastic laminae ruptures. There were no changes in cardiac parameters or the redox stress-induced nuclear translocation of pNRF2 in the aortic tunica media. Altogether, the results suggest that hyperuricaemia interferes neither with aortopathy nor cardiopathy in MFS mice.
Collapse
Affiliation(s)
- Isaac Rodríguez-Rovira
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
| | - Angela López-Sainz
- Department of Cardiology, Hospital Clínic de Barcelona, IDIBAPS, 08036 Barcelona, Spain
| | | | - Belen Pérez
- Department of Pharmacology, School of Medicine, Autonomous University of Barcelona, Bellaterra, 08192 Barcelona, Spain
| | - Francesc Jiménez-Altayó
- Department of Pharmacology, School of Medicine, Autonomous University of Barcelona, Bellaterra, 08192 Barcelona, Spain
| | - Victoria Campuzano
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, 28029 Madrid, Spain
| | - Gustavo Egea
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- UZA/UA Center of Medical Genetics, University of Antwerp, 2650 Edegem, Belgium
| |
Collapse
|
39
|
Gizzarelli M, Foglia Manzillo V, Inglese A, Montagnaro S, Oliva G. Retrospective Long-Term Evaluation of Miltefosine- Allopurinol Treatment in Canine Leishmaniosis. Pathogens 2023; 12:864. [PMID: 37513711 PMCID: PMC10384837 DOI: 10.3390/pathogens12070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Miltefosine-Allopurinol (MIL-AL) combination is reported to be one of the most effective treatments for canine leishmaniosis, thanks to its oral administration and MIL-documented low impact on renal function. However, MIL-AL is considered a second-choice treatment when compared to meglumine-antimoniate-allopurinol combination, mainly due to the risk of earlier relapses. The aim of this study was to evaluate the efficacy of the MIL-AL protocol during a long-term follow-up with an average duration of nine years. Dogs were living in Southern Italy (Puglia, Italy) in an area considered endemic for Canine leishmaniosis (CanL). Inclusion criteria were clinical and/or clinicopathological signs consistent with CanL; positive result to Leishmania quantitative ELISA; and negativity to the most frequent canine vector-borne infections. All dogs received 2 mg/kg MIL for 28 days, and 10 mg/kg AL, BID, for a period varying between 2 and 12 months. Ancillary treatments were allowed according to the clinical condition of the dog. A total clinical score and a total clinicopathological score were calculated at each time point by attributing one point to each sign or alteration present and then by adding all points. Improvement after each treatment was defined by the reduction of at least 50% of the total score. A survival analysis (Kaplan-Meier curve) was performed for quantifying the probability of the events occurring during the study follow-up. The following events were considered: decreased and negative ELISA results; improvement/recovery of the clinical and clinicopathological alterations; and relapse of leishmaniasis. One hundred seventy-three dogs (75f and 98m) were retrospectively included in the study by examining their clinical records since the first diagnosis of CanL. One hundred forty-three (83%) dogs were under five years of age. The mean duration of the follow-up period was 5.4 (±1.1) years with a minimum of 3.2 years and a maximum of 9 years. All dogs received a first treatment of MIL-AL at inclusion; then, during the follow-up course, 30 dogs required a second treatment, 2 dogs required a third treatment and 1 dog required a fourth and a fifth treatment. The mean time interval between the first and the second treatment was 27.2 (±18.3) months. After the first treatment, all dogs had decreased ELISA levels, in an average interval of 2.6 (±1.6) months. One hundred seventy dogs (98%) experienced a clinical improvement (mean time 3.0 ± 4.9 months); 152 (88%) dogs were considered clinically recovered after a mean time of 16.7 ± 13.5 months. A similar trend was observed for clinicopathological alterations; interestingly, proteinuria decreased in most dogs (p < 0.0001-Chi-square for trends). Thirty dogs experienced relapses, the earliest after 4.8 months. The mean time without relapse was 90.4 (±2.5) months. In relapsed dogs, the mean time for clinical improvement after the second treatment was 8.6 (±12.6) months, whereas it was 11.0 (±15.4) months for clinicopathological alterations. Five dogs had limited gastrointestinal side effects associated with MIL treatment. The present study confirms that the MIL-AL protocol can be considered one of the most effective treatments for CanL therapy, mainly for its capacity to provide a long-time clinical improvement in a large majority of treated dogs. As reported in the literature, the clinical stabilization of dogs does not occur immediately after treatment, probably due to the particular pharmacokinetic properties of MIL. The efficacy of MIL-AL decreases in dogs that need more than one treatment, suggesting the necessity to alternate anti-Leishmania drugs for the treatment of relapses. Side effects were transient and slight, even in dogs that required several treatments.
Collapse
Affiliation(s)
- Manuela Gizzarelli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy
| | - Valentina Foglia Manzillo
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy
| | - Antonio Inglese
- Ambulatorio Veterinario Dr. Antonio Inglese, 74023 Grottaglie, Italy
| | - Serena Montagnaro
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy
| | - Gaetano Oliva
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy
| |
Collapse
|
40
|
Reyes-Ramos AR, Preclaro IAC, Castillo MMS, Basco SES. Stevens-Johnson Syndrome in an Adult Filipino Male Positive for HLA-B*38:16 and B*58:17, Associated With Allopurinol: A Case Report. J Clin Pharmacol 2023; 63:742-744. [PMID: 36790080 DOI: 10.1002/jcph.2213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Ana Rouselle Reyes-Ramos
- Department of Dermatology and Venereology, Department of Health, Tondo Medical Center, Manila, Philippines
| | - Ivan Arni C Preclaro
- Department of Dermatology and Venereology, Department of Health, Tondo Medical Center, Manila, Philippines
- Department of Dermatology, Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium, Caloocan, Philippines
| | - Michelle Marie S Castillo
- Department of Dermatology and Venereology, Department of Health, Tondo Medical Center, Manila, Philippines
| | - Sarah Elizabeth S Basco
- Department of Dermatology and Venereology, Department of Health, Tondo Medical Center, Manila, Philippines
| |
Collapse
|
41
|
Ganz M, Alessandro C, Jacobs M, Miller D, Gejerman Y, Okoye F, Jamieson S, Winer A. Investigating the Anti-inflammatory Effect of Allopurinol on the Prevention of Prostate Cancer. Cureus 2023; 15:e40058. [PMID: 37425589 PMCID: PMC10325819 DOI: 10.7759/cureus.40058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Gout is a form of arthritis that arises from the accumulation of uric acid in the bloodstream. Allopurinol, a medication that reduces uric acid levels, has also been shown to have anti-inflammatory effects. Research in this area seems to have mixed results. Furthermore, limited research has examined the relationship between gout treated with Allopurinol and its possible protective factors against prostate cancer. The purpose of this study was to examine the relationship between Allopurinol use and prostate cancer, controlling for demographic and metabolic factors. Methods Information was collected from the National Health and Nutrition Examination Survey (NHANES) dataset of the Centers for Disease Control and Prevention (CDC). Logistic regression analysis was employed to establish the correlation between the usage of Allopurinol and the occurrence of prostate cancer while considering variables such as weight, hypertension, hyperlipidemia, race, educational level, and marital status. The research received approval from the review board of the Physician's Journal of Medicine. Results We found no significant association between Allopurinol use and prostate cancer, controlling for covariates. Age was found to have a positive association with prostate cancer. Marriage was found to have a negative association with prostate cancer. Conclusion The results of this study did not find a significant association between Allopurinol use and the risk of prostate cancer. However, this study adds to the limited body of research examining the relationship between gout, Allopurinol, and prostate cancer and suggests that further research is needed in this area. Overall, while Allopurinol has been shown to have anti-inflammatory effects and is used to treat gout, its use does not appear to have a significant impact on the risk of developing prostate cancer.
Collapse
Affiliation(s)
- Marc Ganz
- Public Health Sciences, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Christopher Alessandro
- Public Health Sciences, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Menachem Jacobs
- Public Health Sciences, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Daniel Miller
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, USA
| | | | - Frederick Okoye
- Urology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Scott Jamieson
- Urology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Andrew Winer
- Urology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| |
Collapse
|
42
|
Yang L, Wu H, Luo C, Zhao Y, Dai R, Li Z, Zhang X, Gong Z, Cai Z, Shen Y, Yu F, Li W, Zhao H, Zhang T, Zhu J, Fu Y, Wang J, Kong W. Urate-Lowering Therapy Inhibits Thoracic Aortic Aneurysm and Dissection Formation in Mice. Arterioscler Thromb Vasc Biol 2023; 43:e172-e189. [PMID: 37128913 DOI: 10.1161/atvbaha.122.318788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Thoracic aortic aneurysm and dissection (TAAD) is a highly lethal vascular disease without effective drug therapy. Whether elevated serum concentrations of uric acid are involved in TAAD development remains unclear. METHODS Serum uric acid levels were detected in different TAAD mouse models and patients. The urate-lowering drug allopurinol was administered in the drinking water of TAAD mice. Adenine diet-induced mice were established to investigate the role of hyperuricemia in TAAD formation and RNA-sequencing of thoracic aortas from these mice was performed. RESULTS We found serum uric acid levels were elevated in various mouse TAAD models, including mice fed a β-aminopropionitrile diet, Marfan mice with fibrillin-1 haploinsufficiency (Fbn1C1041G/+), and ApoE-/- mice infused with Ang II (angiotensin II), as well as in patients with TAAD. Administration of urate-lowering drug allopurinol in the drinking water significantly alleviated TAAD formation in β-aminopropionitrile-treated mice, Fbn1C1041G/+ mice, and Ang II-infused ApoE-/- mice. Moreover, an adenine diet was used to induce hyperuricemia in mice. Intriguingly, a 4-week adenine diet feeding directly induced TAAD formation characterized by increased maximal thoracic aortic diameters and severe elastin degradation, which were ameliorated by allopurinol. Unbiased RNA-sequencing in mouse thoracic aortas suggested that FcγR (Fc gamma receptor) was upregulated upon adenine diet, but reciprocally repressed by allopurinol. Mechanistically, hyperuricemia activated FcγR-mediated ERK1/2 (extracellular signal-regulated kinase 1/2) phosphorylation to induce macrophage inflammation and TAAD development, which was abrogated by allopurinol or FcγR deficiency. CONCLUSIONS This study uncovered an important and previously unrecognized role of hyperuricemia in mediating the pathogenesis of TAAD, and uric acid-lowering drug may represent a promising therapeutic approach for TAAD.
Collapse
Affiliation(s)
- Liu Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
- Wuxi School of Medicine, Jiangnan University, Wuxi, China (L.Y.)
| | - Hao Wu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Congcong Luo
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, China (C.L., J.Z.)
| | - Yang Zhao
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China (Y.Z.)
| | - Rongbo Dai
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Zhiqing Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Xu Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Ze Gong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Zeyu Cai
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Yicong Shen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Fang Yu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Wei Li
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China. (W.L.)
| | - Hongmei Zhao
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Department of Pathophysiology, Peking Union Medical College, Beijing, China (H.Z., J.W.)
| | - Tao Zhang
- Vascular Surgery Department, Peking University People's Hospital, Beijing, China. (T.Z.)
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, China (C.L., J.Z.)
| | - Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| | - Jing Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Department of Pathophysiology, Peking Union Medical College, Beijing, China (H.Z., J.W.)
| | - Wei Kong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University Health Science Center, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China (L.Y., H.W., R.D., Z.L., X.Z., Z.G., Z.C., Y.S., F.Y., Y.F., W.K.)
| |
Collapse
|
43
|
Abstract
INTRODUCTION Hyperuricemia is an overlooked cardiovascular and renal risk factor. Epidemiological and genetic studies have shown an independent role of uric acid in the risk of coronary artery disease, heart failure, chronic kidney disease, and cardiovascular mortality. Treatment options include xanthine oxidase inhibitors, uricosuric medications, and the recombinant uricases. Whether to treat asymptomatic hyperuricemia, and to which target, remains debated. However, the results of recent trials and meta-analysis seem to support this therapeutic strategy. AREAS COVERED In the present review, we summarized current therapeutic indications and options for the treatment of symptomatic and asymptomatic hyperuricemia. Furthermore, we searched the recent literature (last 5 years: 2018 to 2022) to report the results of randomized controlled trials and meta-analysis on cardiovascular and nephroprotective effects of hypouricemic agents. EXPERT OPINION Future large well-designed clinical trials on the role of hypouricemic agents in nephroprotection and cardiovascular prevention and treatment are warranted and may extend their indications and use, with a direct impact on morbidity and mortality. Differentiating between hyperproducing and hypoexcreting phenotypes may help designing future trials improving the consistency of results. Finally, medications with cardio and nephroprotective properties have shown to reduce serum uric acid levels and may be used in patients with hyperuricemia and other cardiovascular complications.
Collapse
Affiliation(s)
- Federica Piani
- Cardiovascular Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Davide Agnoletti
- Cardiovascular Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudio Borghi
- Cardiovascular Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Cardiovascular Internal Medicine, Cardiothoracic Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| |
Collapse
|
44
|
Mitsuboshi S, Kotake K. Association between use of febuxostat and muscle injury: A disproportionality analysis and meta-analysis of randomized controlled trials. Br J Clin Pharmacol 2023; 89:956-966. [PMID: 36585759 DOI: 10.1111/bcp.15655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
AIMS Several reports have suggested an association between febuxostat and muscle injury. The purpose of this study was to determine whether febuxostat increases the risk of muscle injury. This study included an analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS) database and a systematic review/meta-analysis of randomized controlled trials. METHODS First, evaluation of the FAERS data included a disproportionality analysis that compared patients with and without rhabdomyolysis according to whether they were receiving febuxostat or allopurinol. Second, a systematic review/meta-analysis was performed to assess the risk of rhabdomyolysis and muscle injury in patients who used febuxostat or allopurinol. RESULTS Analysis of the FAERS data revealed disproportionality for increasing rhabdomyolysis in patients who received febuxostat (reporting odds ratio 4.49, 95% confidence interval [CI] 3.72-5.38, P < .01) and allopurinol (reporting odds ratio 2.49, 95% CI 2.25-2.75, P < .01). Nineteen studies were eligible for inclusion in the systematic review/meta-analysis. Rhabdomyolysis was reported in only 1 study. The risk of any type of muscle damage was not significantly increased with febuxostat compared with placebo (risk ratio 0.92, 95% CI 0.73-1.17, P = .52, I2 = 0%; 8 studies including 2597 participants, high-certainty evidence) or allopurinol (risk ratio 1.03, 95% CI 0.94-1.11, P = .56, I2 = 0%; 9 studies including 17 644 participants, moderate-certainty evidence). CONCLUSION Febuxostat does not seem to affect the risk of muscle injury. However, the findings of this meta-analysis indicate a need for further high-quality observational studies with long-term follow-up.
Collapse
Affiliation(s)
| | - Kazumasa Kotake
- Department of Pharmacy, Okayama Saiseikai General Hospital, Okayama, Japan
| |
Collapse
|
45
|
Liu CH, Huang SC, Yin CH, Huang WC, Chen JS, Chen YS, Gan ST, Tzou SJ, Hsu CT, Wu HM, Wang WH. Atrial Fibrillation Risk and Urate-Lowering Therapy in Patients with Gout: A Cohort Study Using a Clinical Database. Biomedicines 2022; 11:biomedicines11010059. [PMID: 36672567 PMCID: PMC9855783 DOI: 10.3390/biomedicines11010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Individuals of Asian descent are at higher risk for developing hyperuricemia and gout as compared to Western populations. Urate-lowering therapy (ULT) is an effective treatment for hyperuricemia and gout. It was reported that febuxostat, one of the ULTs, raises the risk of atrial fibrillation (AF) in elderly populations. Nevertheless, this association has not been properly investigated in Asian populations. We aimed to investigate the development of AF after ULT with different drugs in an Asian population. We conducted a retrospective cohort study using the clinical database at Kaohsiung Veterans General Hospital. Patients newly diagnosed with gout between 1 January 2013 and 31 December 2020 and with a documented baseline serum uric acid (sUA) level but no prior diagnosis of AF were identified. Patients were divided into three groups-allopurinol, benzbromarone, and febuxostat users. During the follow-up period, the risks of incident AF following the initiation of ULT with different drugs were assessed. Development of incident AF was noted in 43 (6%) of the 713 eligible patients during the follow-up period (mean, 49.4 ± 26.6 months). Febuxostat-treated patients had a higher prevalence of certain comorbidities (diabetes mellitus, heart failure, and chronic kidney disease) and higher CHA2DS2-VASc scores. Compared with allopurinol, neither febuxostat nor benzbromarone was associated with increased adjusted hazard ratios (HR) for incident AF (HR: 1.20, 95% confidence interval [CI]: 0.43-3.34; HR: 0.68, 95% CI: 0.22-2.08). There was no difference in the risk of incident AF among Asian patients with gout who received febuxostat, allopurinol, or benzbromarone. Further studies are needed to evaluate long-term cardiovascular outcomes in patients receiving different ULT drugs.
Collapse
Affiliation(s)
- Ching-Han Liu
- Division of Cardiology, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Shih-Chung Huang
- Division of Cardiology, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Institute of Health Care Management, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Yao-Shen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Su-Ting Gan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Shiow-Jyu Tzou
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Ching-Tsai Hsu
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Division of Cardiology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
| | - Hao-Ming Wu
- Division of Cardiology, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Wen-Hwa Wang
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Institute of Management, I-Shou University, Kaohsiung 84001, Taiwan
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London UB9 6JH, UK
- Correspondence:
| |
Collapse
|
46
|
Yang N, Cao B. Low-dose febuxostat exhibits a superior renal-protective effect and non-inferior safety profile compared to allopurinol in chronic kidney disease patients complicated with hyperuricemia: A double-centre, randomized, controlled study. J Clin Pharm Ther 2022; 47:2214-2222. [PMID: 36403976 DOI: 10.1111/jcpt.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The present study compared the efficacy and safety of low-dose febuxostat versus allopurinol in chronic kidney disease (CKD) patients complicated with hyperuricemia (HUA). METHODS In this double-centre, randomized, controlled study, 120 CKD patients complicated with HUA were recruited and randomly assigned to low-dose febuxostat group (20 mg/day) or allopurinol group (200 mg/day) at 1:1 ratio. The serum creatinine (Scr), serum uric acid (SUA), and estimated glomerular filtration rate (eGFR) were measured at baseline (M0), month (M) 1, M3, and M6. Besides, the drug-related adverse events (AEs) were recorded. The primary outcome was the proportion of patients showing a > 10% decline in eGFR from M0 to M6. RESULTS The eGFR level was increased at M6, but similar at M0, M1 and M3 in febuxostat group compared with allopurinol group. Notably, the proportion of patients with >10% decline in eGFR from M0 to M6 was decreased in febuxostat group compared with allopurinol group. However, there was no difference of Scr, SUA at M0, M1, M3 and M6 between febuxostat group and allopurinol group. Moreover, there was no difference of drug-related AEs between febuxostat group and allopurinol group. Further subgroup analysis exhibited that low-dose febuxostat presented superior effect on attenuating eGFR decline and lowering SUA level compared with allopurinol in CKD stage 3 subgroup, but not in CKD stage 2 subgroup. CONCLUSION Low-dose febuxostat may exhibit a superior renal-protective effect, non-inferior SUA lowering ability and safety profile compared with allopurinol in CKD patients complicated with HUA.
Collapse
Affiliation(s)
- Na Yang
- Department of Nephrology, Shangluo Central Hospital, Shangluo, China
| | - Bin Cao
- Department of Nephrology, Ankang Hospital of Traditional Chinese Medicine, Ankang, China
| |
Collapse
|
47
|
Coleman GB, Dalbeth N, Frampton C, Haslett J, Drake J, Su I, Horne AM, Stamp LK. Long-Term Follow-up of a Randomized Controlled Trial of Allopurinol Dose Escalation to Achieve Target Serum Urate in People With Gout. J Rheumatol 2022; 49:1372-1378. [PMID: 35777814 DOI: 10.3899/jrheum.220270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the long-term use of and adherence to urate-lowering therapy (ULT), serum urate (SU) control, and self-reported flares in participants from a randomized controlled trial of allopurinol dose escalation, in order to achieve target SU concentration (< 0.36 mmol/L) in people with gout. METHODS For surviving study participants, ULT dispensing and SU testing within the preceding 12 months was obtained by medical record review. A phone interview was conducted to determine self-reported flares and adherence. RESULTS Over a mean follow-up of 6.5 (SD 2.5) years since enrollment, 60 out of 183 (33%) participants had died. Review of the 119 surviving participants showed that 98 (82%) were receiving allopurinol, 5 (4%) were receiving febuxostat, and 10 (8%) were not receiving ULT; for the remaining 6 (5.0%), ULT use could not be determined. In those receiving allopurinol, the mean dose was 28.1 (range -600 to 500) mg/day lower than at the last study visit; 49% were receiving the same dose, 18% were on a higher dose, and 33% were on a lower dose than at the last study visit. SU values were available for 86 of the 119 (72%) participants; 50 out of 86 (58%) participants had an SU concentration of < 0.36 mmol/L. Of the 89 participants who participated in the phone interview, 19 (21%) reported a gout flare in the preceding 12 months and 79 (89%) were receiving allopurinol; 71 (90%) of those receiving allopurinol reported 90% or greater adherence. CONCLUSION Most of the surviving participants in the allopurinol dose escalation study had good real-world persistence with allopurinol, remained at target SU, and had a low number of self-reported flares.
Collapse
Affiliation(s)
- George B Coleman
- G.B. Coleman, MBChB, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital
| | - Nicola Dalbeth
- N. Dalbeth, MBChB, MD, FRACP, I. Su, BSc, A.M. Horne, MBChB, Department of Medicine, University of Auckland, Auckland
| | - Chris Frampton
- C. Frampton, BSc, PhD, J. Haslett, BN, J. Drake, BN, Department of Medicine, University of Otago, Christchurch
| | - Janine Haslett
- C. Frampton, BSc, PhD, J. Haslett, BN, J. Drake, BN, Department of Medicine, University of Otago, Christchurch
| | - Jill Drake
- C. Frampton, BSc, PhD, J. Haslett, BN, J. Drake, BN, Department of Medicine, University of Otago, Christchurch
| | - Isabel Su
- N. Dalbeth, MBChB, MD, FRACP, I. Su, BSc, A.M. Horne, MBChB, Department of Medicine, University of Auckland, Auckland
| | - Anne M Horne
- N. Dalbeth, MBChB, MD, FRACP, I. Su, BSc, A.M. Horne, MBChB, Department of Medicine, University of Auckland, Auckland
| | - Lisa K Stamp
- L.K. Stamp, MBChB, FRACP, PhD, Department of Medicine, University of Otago, Christchurch, and Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand
| |
Collapse
|
48
|
Abstract
BACKGROUND/OBJECTIVE Diabetes mellitus is a common "non-gout" disease with high incidence. Several studies have shown that serum uric acid level in patients with diabetes is higher than that in healthy individuals, and is accompanied by severe albuminuria and high serum creatinine (Scr). Recent clinical studies have found that uric acid-lowering therapy (such as allopurinol) could reduce urinary albumin excretion rates (UAER) and Scr, increase eGFR, and thus reduce kidney damage in patients with diabetes. Therefore, this meta-analysis [PROSPERO CRD42021274465] intended to evaluate the efficacy and safety of allopurinol in patients with diabetes mellitus. METHODS We thoroughly searched five electronic resource databases for randomized controlled trials (RCTs) that compared the efficacy and safety of allopurinol versus conventional treatment or placebo for the treatment of patients with diabetes mellitus. Predetermined outcomes were considered continuous variables, mean difference (MD) was used for the determination of effect size (standardized mean difference [SMD] was used to determine the effect size when there were different evaluation criteria in different articles), and the corresponding 95% confidence interval (CI) was calculated. All outcome measures were analyzed using a random-effects model for data analysis. RESULTS Ten eligible trials with a total of 866 participants were included in the meta-analysis. Allopurinol was more effective in decreasing serum uric acid (SUA) levels compared with conventional treatment (p = 0.0001) or placebo (p < 0.00001). Moreover, the levels of 24-hour urine protein were significantly lower in the allopurinol group (p < 0.00001). The subgroup analysis of Scr showed that the Scr of patients with an allopurinol treatment duration of fewer than six months was significantly lower than that of the control group (p = 0.03). No significant difference in adverse events (AEs) was identified between the treatment and control groups. CONCLUSIONS Our meta-analysis of RCTs showed that oral administration of allopurinol effectively reduced SUA levels in patients with diabetes, and patients' renal function was protected. More RCTs with larger sample sizes and higher quality are needed to clarify the role of allopurinol use in decreasing blood pressure, maintaining blood glucose levels, and improving renal function in patients with diabetes.
Collapse
Affiliation(s)
- Qian Luo
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Beijing, China
| | - Yuzi Cai
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Beijing, China
| | - Qihan Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Beijing, China
| | - Lei Tian
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Beijing, China
| | - Yuning Liu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Beijing, China
| | - Wei Jing Liu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.,Zhanjiang Key Laboratory of Prevention and Management of Chronic Kidney Disease, Guangdong Medical University, Zhanjiang, Guangdong, China
| |
Collapse
|
49
|
Bakr AA, Ali M, Ibrahim K. Garlic and allopurinol alleviate the apoptotic pathway in rats' brain following exposure to fipronil insecticide. Environ Anal Health Toxicol 2022; 37:e2022037-0. [PMID: 36916050 PMCID: PMC10014746 DOI: 10.5620/eaht.2022037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
Fipronil can cause oxidative tissue damage and apoptosis. Our goal is to evaluate the antiapoptotic impact of garlic or allopurinol against fipronil neurotoxicity. Thirty-six mature male albino rats were separated into control, garlic aqueous extract (500 mg/kg), allopurinol (150 mg/L in their drinking water), fipronil (13.277 mg/kg), garlic+fipronil, and allopurinol+fipronil. Our results revealed that fipronil induced a significant increase in brain malondialdehyde, protein carbonyl levels as well as enzymatic antioxidant activities (superoxide dismutase, catalase, glutathione peroxidase, and xanthine oxidase), but glutathione-S-transferase recorded a significant decrease as compared to the control. In addition, fipronil significantly up-regulated the brain pro-apoptotic (Bax) and caspase -3 mRNA gene expression and induced DNA fragmentation but caused down-regulation in anti-apoptotic (Bcl-2) mRNA genes expression. Interestingly, co-administration with garlic or allopurinol improved the lipid peroxidation, antioxidant disturbance, and apoptosis induced by fipronil in the brain tissues. In conclusion, garlic or allopurinol reduced fipronil-induced apoptosis and reduced oxidative tissue damage, most likely through enhancing the tissue antioxidant defense system.
Collapse
Affiliation(s)
- Amira Abo Bakr
- Biochemistry Division, Faculty of Science, Cairo University, Egypt
| | - Mohamed Ali
- Biochemistry Division, Faculty of Science, Cairo University, Egypt
| | - Khairy Ibrahim
- Mammalian Toxicology Department, Central Agricultural Pesticides Laboratory, Agricultural Research Center, Dokki, Giza, 12618, Egypt
| |
Collapse
|
50
|
Coleshill MJ, Day RO, Tam K, Kouhkamari M, Caillet V, Aung E, Kannangara DRW, Cronin P, Rodgers A, Stocker SL. Persistence with urate-lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions. Br J Clin Pharmacol 2022; 88:4894-4901. [PMID: 35675118 PMCID: PMC9795926 DOI: 10.1111/bcp.15435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/12/2022] [Accepted: 05/27/2022] [Indexed: 12/30/2022] Open
Abstract
AIM Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate-lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia. METHODS A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. The number of allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan-Meier curves were used to examine persistence, while Cox regression analysis was used to examine the influence of gender, concomitant colchicine and age. RESULTS The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing allopurinol 300-mg therapy in the first month. Median persistence with allopurinol 300 mg was 5 months (95% confidence interval 4.76-5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co-prescribed colchicine. CONCLUSION Persistence with allopurinol was poor. More effective methods targeting prescribers, patients and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.
Collapse
Affiliation(s)
- Matthew J. Coleshill
- Department of Clinical Pharmacology & ToxicologySt Vincent's HospitalSydneyAustralia,St Vincent's Clinical SchoolUniversity of New South WalesSydneyAustralia
| | - Richard O. Day
- Department of Clinical Pharmacology & ToxicologySt Vincent's HospitalSydneyAustralia,St Vincent's Clinical SchoolUniversity of New South WalesSydneyAustralia
| | - Karson Tam
- Department of Clinical Pharmacology & ToxicologySt Vincent's HospitalSydneyAustralia
| | | | | | - Eindra Aung
- Department of Clinical Pharmacology & ToxicologySt Vincent's HospitalSydneyAustralia,St Vincent's Clinical SchoolUniversity of New South WalesSydneyAustralia
| | - Diluk R. W. Kannangara
- Department of Clinical Pharmacology & ToxicologySt Vincent's HospitalSydneyAustralia,Notre Dame Medical SchoolSydneyAustralia
| | | | - Anthony Rodgers
- George Institute for Global StudiesUniversity of New South WalesSydneyAustralia
| | - Sophie L. Stocker
- Department of Clinical Pharmacology & ToxicologySt Vincent's HospitalSydneyAustralia,St Vincent's Clinical SchoolUniversity of New South WalesSydneyAustralia,Sydney Pharmacy School, Faculty of Medicine & HealthThe University of SydneySydneyAustralia
| |
Collapse
|