Work

Hepatic Safety of Febuxostat and Allopurinol in Gout Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Purpose: This study aimed to conduct an updated systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the hepatic safety of febuxostat and allopurinol in gout patients. Subgroup analyses were conducted based on age, dosage, and treatment duration. Methods: This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published studies were reviewed in PubMed, The Cochrane Library, and Scopus. The Cochrane Risk of Bias (RoB) 2 tool was used to assess the quality of the included studies. Risk ratios (RR) were estimated using binary outcomes of fixed effect model and were reported with corresponding 95% confidence intervals (CI). This study is registered on PROSPERO with number CRD42024611074. Results: Out of 703 publications from the databases, a total of 15 studies met the inclusion criteria. The RR meta-analysis of the included studies was calculated using binary outcomes and a fixed effect model based on available hepatic safety events. We identified 5 RCTs with some concerns regarding the risk of bias, and 10 RCTs with a low risk of bias. Overall, hepatic safety outcomes were comparable between febuxostat and allopurinol, including across subgroups by age, dosage, and treatment duration. Febuxostat showed no significant difference in hepatic risk compared to allopurinol, with RRs of 1.03 (95% CI: 0.78-1.36) for overall liver function abnormalities, 1.03 (95% CI: 0.66-1.61) for investigator-defined liver abnormalities, and 1.21 (95% CI: 0.96-2.74) for hepatobiliary disorders. Conclusion: This updated systematic review and meta-analysis found no difference in hepatic safety profiles between febuxostat and allopurinol in patients with gout across age categories, dosage levels, or treatment durations. Further research is warranted to address the limitations of sample sizes and the overall moderate quality of existing evidence.

Source: Therapeutics and Clinical Risk Management

DOI: 10.2147/tcrm.s552281

Authors: Christiyanti Dewi, Falerina Puspita, Widya Insani, Rano Sinuraya, Irma Puspitasari, Neily Zakiyah

Institution: Padjadjaran University

Language: English

Topic: Gout, Hyperuricemia, Uric Acid

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836