Clinical Effects of Xanthine Oxidase Inhibitors in Hyperuricemic Patients

Arrigo F G Cicero, Federica Fogacci, Raffaele Ivan Cincione, Giuliano Tocci, Claudio Borghi

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This review aim is to critically resume the available clinical evidence supporting the treatment of chronic hyperuricemia with xanthine-oxidase inhibitor activity. For this reason, all of the studies published in English language from 2000 to August 2019 on uric acid-lowering drugs have been carefully reviewed. The terms "serum uric acid", "xanthine oxidase", "allopurinol", "febuxostat", and "topiroxostat" have been incorporated into an electronic search strategy, alone and in combinations, in both MEDLINE (National Library of Medicine, Bethesda, MD) and the Cochrane Register of Controlled Trials (The Cochrane Collaboration, Oxford, UK). Even if new urate lowering drugs seem of particular efficacy for acute treatment of refractory hyperuricemia, their use is supported by relatively small clinical evidence: On the contrary, large long-term clinical trials have clearly demonstrated that xanthine oxidase inhibitors (namely, allopurinol and febuxostat) are effective, safe and relatively well-tolerated in the most part of patients. They have been largely tested in elderly, in patients affected by crhonic diseases such as heart failure and cancer, and in patients taking a large number of drugs, confirming their safety profile. Recent data also show that they could exert some positive effects on vascular health, renal function and glucose metabolism. Their cost is also low. In conclusion, xanthine oxidase inhibitors remain the first choice uric acid lowering drug for chronic treatment.


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