Network meta-Analysis of drug therapies for lowering uric acid and mortality risk in patients with heart failure
Network meta-Analysis of drug therapies for lowering uric acid and mortality risk in patients with heart failure
复制标题
降低心力衰竭患者尿酸和死亡风险的药物治疗的网络荟萃分析
DOI：
10.1007/s10557-020-07097-4
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发表时间：
2020
影响因子：
3.4
通讯作者：
Sone H
中科院分区：
文献类型：
--
作者：
Kodama S;Fujihara K;Horikawa C;Yamada M;Sato T;Yaguchi Y;Yamamoto M;Kitazawa M;Matsubayashi Y;Yamada T;Watanabe K;Sone H
目的：本网络荟萃分析旨在评价心力衰竭患者应用药物降低尿酸水平以降低死亡率的当前疗效。方法应用EMBASE和MEDLINE数据库检索1950年1月1日至2019年12月26日发表的研究文献，纳入至少一组服用降尿酸药物的患者，研究结果为全因死亡率。在频域框架内进行了随机效应网络荟萃分析。处理等级以累积排名曲线(SUCRA)值下的表面表示，与平均排名成正比(最好为100%)。结果9项研究包括7个不同类型的组，符合分析条件。有高尿酸血症但未经治疗的“未经治疗的尿酸血症”组的死亡风险显著高于无高尿酸血症患者的“无尿酸血症”组(相对风险(RR)(95%可信区间，1.43(1.08-1.89)。患者开始服用别嘌醇的“Start-allo”组的死亡率并不显著低于“未经治疗的尿酸血症”组(RR(95%CI)，0.68(0.45-1.01))。然而，在“Start-allo”组中，SUCRA值与“无尿酸血症”组相似(“Start-allo”组SUCRA值为65.4%；“无尿酸血症组”为64.1%)。结论：就死亡率而言，别嘌醇治疗并不能显著改善心力衰竭患者的预后，但有可能抵消长期高尿酸血症的不良反应。
PurposeThis network meta-analysis aimed to assess the current efficacy of decreasing the uric acid (UA) level with drugs to reduce mortality in patients with heart failure (HF).MethodsElectronic literature searches using EMBASE and MEDLINE of studies published from 1 Jan 1950 to 26 Dec 2019 were conducted for randomized controlled trials or non-randomized cohort studies that included at least one group of patients who took UA-lowering drugs and with a study outcome of all-cause mortality. A random-effects network meta-analysis was performed within a frequentist framework. Hierarchy of treatments was expressed as the surface under the cumulative ranking curve (SUCRA) value, which is in proportion to mean rank (best is 100%).ResultsNine studies, which included seven different types of groups, were eligible for analysis. The “untreated uricemia” group in which patients had hyperuricemia but without treatment had a significantly higher risk of mortality than the “no uricemia” group in which patients had no hyperuricemia (relative risk (RR)(95% confidence interval (CI), 1.43 (1.08–1.89)). The “start-allo” group wherein patients started to take allopurinol did not have a significantly lower risk of mortality than the “untreated uricemia” group (RR (95% CI), 0.68 (0.45–1.01)). However, in the “start-allo” group the SUCRA value was comparable to that in the “no uricemia” group (SUCRA: 65.4% for “start-allo”; 64.1% for “no uricemia”).ConclusionsResults suggested that allopurinol therapy was not associated with a significantly improved prognosis in terms of mortality but could potentially counteract the adverse effects associated with longstanding hyperuricemia in HF patients.