Because of accumulation of information on hyperuricemia and gout since 2010, the 3rd edition of the guideline for the management of hyperuricemia and gout is now going to be processed. After setting the important clinical issues on hyperuricemia and gout, seven clinical questions accompanied by several advantage and disadvantage outcomes have been selected. Using the systematic reviews on reports related to outcome of each clinical question, bias risk of each evidence has been estimated. Taken together with the estimation of body of evidence, the recommendation for the each clinical question will be determined. In addition to clinical questions, review paper regarding the clinical issues of hyperuricemia and gout will be prepared. Thus, this guideline is expected to cover the decision making regarding the important clinical issues on hyperuricemia and gout.
Tumor lysis syndrome (TLS) causes hyperuricemia in patients with malignancies under chemotherapeutic treatment. Lowering serum uric acid (S-UA) levels is the most important. Febuxostat has been officially used for chemotherapy-associated hyperuricemia since May 2016 in Japan. Rasburicase and febuxostat reduce S-UA. Rasburicase is effective for high-risk TLS, and febuxostat for low-intermediate risk. Here, febuxostat was evaluated as a treatment for cancer-related hyperuricemia after becoming officially employed for TLS (June 2016 - November 2017). Sixty milligram was taken by mouth. The first chemotherapeutic treatment was started within a day after the first 60 mg dosing. The primary endpoint was S-UA normalization (≤ 7 mg/dL) on day 7 of chemotherapy. Twenty-four patients were evaluated (median: 70 years, range: 52-89 years, 14 males/10 females). The baseline S-UA was 7.2±2.7 mg/dL (mean±SD), and S-UA on the 7th day of chemotherapy was 2.5± 1.3 mg/dL (P<0.0001, by paired t-test). All patients met the primary endpoint. In addition, the baseline creatinine was 1.1±0.6 mg/dL (mean±SD), and the value on the 7th day of chemotherapy was 0.8±0.3 mg/dL (P=0.031, by paired t-test). Developing TLS was not observed. Severe adverse reactions were not noted. Thus, 60-mg febuxostat was effective against cancer-associated hyperuricemia.
Aim: Evidence has emerged that glycosuria is associated with lowering of serum uric acid (UA) levels in patients with diabetes mellitus (DM). The present study investigated whether glycosuria, per se, is involved in the lowering of UA levels in type 2 diabetic patients without hypoglycemic agents with uricosuric property.
Subjects & Methods: Individuals who underwent a annual medical check-up and met the inclusion criteria were recruited for this cross-sectional analysis. Diabetic patients being treated with sodium glucose cotransporter 2 (SGLT2) inhibitors were excluded from the analysis. The final participants were a total of 11,649 males, which consisted of euglycemics, prediabetics, and diabetics. Multiple regression analysis was employed to estimate factors influencing serum UA level.
Results: The UA level in the overall diabetics (5.9 ± 1.4mg/dL, n=704) was comparable with that in euglycemics (6.0 ± 1.1mg/dL, n=9,871). Prediabetics had the highest UA level among the subgroups (6.6 ± 1.3mg/dL, n=1,074). The UA level in diabetics with glycosuria (5.5 ± 1.3mg/dL, n=197) was lower than that in diabetics without glycosuria (6.0 ± 1.2mg/ dL, n=507, p<0.01). In addition, the severity of glycosuria had a negative correlation with the lowering of UA levels in diabetics. In addition, poor diabetic control was associated with the severity of glycosuria. Multiple regression analysis revealed that factors to predict the lowering of UA levels in diabetics were: age, estimated glomerular filtration rate (eGFR), and presence of glycosuria.
Conclusion: There is a close association between glycosuria and lowering of serum UA levels in patients with DM not being treated with SGLT2 inhibitors.