Journal of Applied Medical Sciences

The Safety and Efficacy of Lesinurad in Combination with Allopurinol versus Allopurinol Alone in Patients with Gout: A Systematic Review and Meta-Analysis

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  • Abstract

     

    Background: Lesinurad approved by the US FDA in December 2015. This study assess the efficacy and safety of the combination of lesinurad and allopurinol in gout patients who are non-responsive to allopurinol alone using meta-analysis method.

    Method: Search performed in multiple databases from inception to May 2019. Double-blinded RCTs of lesinurad in combination with allopurinol versus allopurinol alone were applied. Three studies, 922 patients met our inclusion criteria. The primary outcome was the number of subjects achieving a serum urate level <6.0 mg/dL at any follow-up point; the secondary endpoints were the number of tophi with complete resolution; any reported gout flares, any serious adverse events, withdrawal, or death.

    Results: The relative risk showed a significant reduction in serum urate levels <6 mg/dL in lesinurad 400mg group versus the allopurinol alone group (RR=2.51, 95% CI=2.12- 2.98). Two studies reported reductions in gout flares between the groups (RR=-0.07, 95%CI=-0.08 --0.05). The lesinurad group showed higher serious adverse events when compared with allopurinol alone (RR=1.87, 95%CI=1.09- 3.21).

    Conclusion: Lesinurad 400mg in combination with allopurinol showed significant reduction in urate levels <6 mg/dL and in number of gout flares. However, there were higher AEs with the combination therapy of lesinurad and allopurinol.


    Keywords: Systematic review, Meta-analysis, Lesinurad, Gout, Allopurinol