Excessive serum uric acid reduction harmful in older hyperuricaemic patients
Excessive serum uric acid (SUA) reduction may be harmful in older hyperuricaemic populations, according to a study published in the Rheumatology. Further Optimal serum uric acid level by febuxostat treatment is 5–6 mg/dl for reducing all-cause mortality, cerebral, cardiovascular, and renal events.
Hyperuricaemia is recognised as an independent risk marker for cardiovascular and renal diseases. However, uric acid is a powerful free-radical scavenger, and the optimal level of serum uric acid (SUA) determining outcomes are unknown.
A group of researchers from Japan conducted a study to explore whether interventional treatments for excessive serum uric acid (SUA) reduction were harmful and what constituted the optimal lowering of serum uric acid (SUA) levels for the prevention of events in patients with asymptomatic hyperuricaemia.
This was a post hoc analysis of a randomised trial (Febuxostat for Cerebral and CaRdiorenovascular Events PrEvEntion StuDy [FREED]) in which 1070 older patients with asymptomatic hyperuricaemia were enrolled and allocated to febuxostat (n = 537) or non-febuxostat treatment group (n = 533). We assessed the relationship between the endpoint (withdrawal or study completion) SUA levels and clinical outcomes. The primary endpoint was defined as a composite of all-cause mortality, cerebral and cardiorenovascular events.
The results of the study are as follows:
· In the febuxostat group, patients achieving serum uric acid (SUA) levels ≤4 mg/dl, >4 to ≤ 5 mg/dl and >7 mg/dl had significantly higher risks for a primary composite event than those achieving serum uric acid (SUA) levels >5 to ≤ 6 mg/dl.
· This J-shaped relationship applied to patients with renal impairment and was not significant in the non-febuxostat treatment group.
Thus, the researchers concluded that optimal serum uric acid (SUA) levels by febuxostat treatment is 5–6 mg/dl for reducing all-cause mortality, cerebral, cardiovascular, and renal events. Excessive serum uric acid (SUA) reduction may be harmful in older hyperuricaemic populations.
A study titled, "Optimal uric acid levels by febuxostat treatment and cerebral, cardio renovascular risks: post hoc analysis of a randomised controlled trial" by Sunao Kojima et. al published in the Rheumatology.