POS1167 EFFICACY AND SAFETY OF FEBUXOSTAT IN PATIENTS WITH STAGE 4-5 CHRONIC KIDNEY DISEASE NOT YET ON DIALYSIS: A META-ANALYSIS OF OBSERVATIONAL STUDIES

Abstract

BackgroundThe efficacy and safety of febuxostat in patients with stage 4-5 chronic kidney disease (CKD) are still unclear, even though it’s commonly used in clinical practice [1]. However, clinical trials are lacking to determine them due to ethical problems about enrollment of advanced CKD patients.ObjectivesWe aimed to evaluate the efficacy and safety of febuxostat in patients with stage 4-5 CKD not yet on dialysis through a meta-analysis of observational studies.MethodsWe performed a systematic search in PubMed, Ovid MEDLINE, Embase, and the Cochrane Library to find articles reporting on advanced CKD patients from observational cohorts who start or take febuxostat at baseline in September 2021. Articles had to describe change from baseline in serum urate levels and renal function as assessed by estimated glomerular filtration rate (eGFR). The articles were screened by two independent reviewers (YP, HJ). Meta-analysis using a random-effects model was performed. R software was used for statistical analyses.ResultsAmong 148 retrieved studies, 5 relevant observational studies were included in the meta-analysis. The febuxostat dose was administered at 10-120 mg per day, and the treatment period was 3 to 12 months. Five studies were included with a total of 327 patients to analyze urate-lowering efficacy. The urate-lowering effect after use of febuxostat medication showed statistical significance (weighted mean difference, -1.85; 95% CI, -2.04 to -1.67; I2; 0%, Figure 1A). Three studies with 145 patients were available for assessment of eGFR. Renal function as assessed by eGFR did not decrease even after use of febuxostat (weighted mean difference, 0.11; 95% CI, -0.25 to 0.47; I2; 45%, Figure 1B).Figure 1.Meta-analyses of serum urate levels and estimated glomerular filtration rate at baseline and follow-up.ConclusionOur meta-analysis showed that febuxostat had good urate-lowering efficacy and renal safety in hyperuricemia patients with stage 4-5 CKD, who are not yet on dialysis. More studies with larger sample sizes and higher quality are required to clarify the efficacy and safety of febuxostat in advanced CKD.