Highlights
- •Preventive treatment of asymptomatic non-severe hyperuricemia is not recommended.
- •Allopurinol may be considered in AH in three conditions (Table 5).
- •Long-term data on cardiovascular and chronic kidney disease prevention are needed.
Abstract
While there is consensus on starting urate-lowering therapy (ULT) in cases of symptomatic
hyperuricemia, the frequent condition of asymptomatic hyperuricemia (AH) remains a
challenge due to differences in the findings of studies that have addressed the issue.
Uric acid has anti-oxidant properties, but high levels predispose to gout and may
play a role in metabolic syndrome. We systematically evaluated randomized controlled
trials (RCTs) addressing ULT in patients with AH, to assess the current evidence.
We found broad heterogeneity among the studies (13 RCTs), in terms of study design
and population, making findings challenging to interpret and generalize; hard end-points
were not assessed. Allopurinol is often prescribed for AH despite the fact that its
use is not backed by conclusive evidence from prospective RCTs, nor is it recommended
by the guidelines. Its potential benefits, in terms of absolute risk reduction, must
be weighed against its potential for harm since it can trigger severe adverse hypersensitivity
reactions, sometimes even fatal. RCTs with hard end-points are needed to assess the
risk/benefit of lowering uric acid in subjects with AH, particularly as secondary
prevention for cardiovascular risk and in patients with different degrees of renal
disease. To date, particularly after the result from the CARES trial, preventive treatment
of asymptomatic and non-severe hyperuricemia is not recommended.
Keywords
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Article info
Publication history
Published online: January 15, 2020
Accepted:
January 4,
2020
Received in revised form:
January 2,
2020
Received:
October 29,
2019
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
