The Efficacy And Safety Of Febuxostat Versus Allopurinol In Hyperuricemia Patients With CKD:A Meta-analysis

Objective: The objective of this study is to provide evidence-based medical evidence about efficacy and safety of febuxostat and allopurinol in the treatment of patients with chronic kidney disease(CKD)with hyperuricemia(HUA)for their clinical application.The published randomized controlled trials(RCT)related to efficacy and adverse reactions of febuxostat and allopurinol in CKD with HUA have been compared by Meta-analysis.Methods: Databases of CNKI,VIP,Wanfang,Cochrane Library,Medline database,Web of Science,Pub Med were reviewed according to the established retrieval methods and inclusion and exclusion criteria to collect Literatures.Rev Man 5.3 software was used for data consolidation analysis,and to analyze the efficacy and the incidence of adverse reactions by forest map.The included literatures were evaluated by Cochrane manual for quality and funnel plot for publication bias.Results: A total of 11 articles were included in the literature,2 in English and 9 in Chinese.All 11 studies were RCT experiments with a total of 1025 patients,including 514 in the febuxostat and 511 in the allopurinol.Meta-analysis showed that the reduction of s UA(P < 0.00001),the reduction of serum creatinine(P < 0.0001),and the increase of e GFR(P=0.003)in the febuxostat were significantly higher than those in the allopurinol,and the total incidence of adverse reactions(P = 0.002)was significantly lower than that in the allopurinol.The difference was statistically significant.Subgroup analysis was performed according to the follow-up time.The results showed that the RCT with unknown follow-up time,the reduction of s UA in the febuxostat(P=0.0005)and the decrease in serum creatinine(P=0.02)were significantly higher than those in the allopurinol.The difference was statistically significant.During the follow-up time of 2 months RCT,the reduction of s UA(P<0.00001)and the increase of e GFR(P=0.004)in the febuxostat were significantly higher than those in the allopurinol.The difference was statistically significant.During the follow-up of 6 months of RCT,the reduction of s UA(P = 0.0005),the reduction of serum creatinine(P=0.001),and the increase of e GFR(P=0.01)in the febuxostat were significantly higher than those in the allopurinol,and the differences were statistically significant.The funnel plots drawn with various indicators showed that the funnel plots based on s UA and e GFR were asymmetrical,suggesting that there may be publication bias,and the funnel plots based on creatinine and adverse reactions were symmetric,suggesting that there may be no publication bias.Conclusions: 1.Compared with allopurinol,febuxostat significantly reduced the level of s UA in patients with CKD and HUA,suggesting a better efficacy in the treatment of CKD and HUA.2.Compared with allopurinol,febuxostat significantly reduced serum creatinine and improved e GFR in patients with CKD and HUA,suggesting a better effect on renal function.3.Compared with allopurinol,febuxostat has a lower incidence of adverse reactions and higher safety in the treatment of patients with CKD and HUA.