Medicines

Umbrella review clears fogginess abound uric acid


There is no evidence to expand the use of uric acid lowering drugs beyond current indications for gout or nephrolithiasis, according to a comprehensive review of the evidence.

The umbrella review’ comprised 144 meta-analyses of observational studies, 32 meta-analyses of randomised controlled trials and 107 Mendelian randomisation analyses.

The findings should put to bed any lingering suspicions about elevated serum uric acid levels playing a direct role in other conditions such as cardiovascular disease.

Rheumatologist Dr Philip Robinson, from the Royal Brisbane and Women’s Hospital and the University of Queensland, told the limbic the findings were consistent with current practice in Australia.

He said the vast majority of clinicians did not consider treating elevated uric acid levels for conditions other than gout and kidney stones.

“Uric acid is a biomarker of metabolic dysfunction but that doesn’t mean it’s causal. This is a robust study, published in the BMJ, in which the authors have gone through the data carefully and confirmed that there is no link. The data is not there to support any direct causal effect of serum urate.”

The review found some observational evidence to implicate serum urate in hypertension and chronic kidney disease, but these findings were only partly supported by randomised controlled trials and not by Mendelian randomisation studies.

“We would see a pervasive effect over time if something significant was happening. If multiple studies are done well, the findings should cluster tightly together,” Dr Robinson said.

He added small isolated studies with positive findings could represent true results but in non-representative populations.

The review also found no adequate evidence that urate-lowering treatment for gout was associated with neurological conditions.

While there was some, inconsistent evidence for an association between low serum urate and neurological disease in observational studies, the researchers said it was not supported by Mendelian randomisation studies.

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