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Allopurinol safety and efficacy in heart failure patients: a systematic review

Session Poster Session 2

Speaker Mohammad Mostafa Ansari Ramandi

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : H Yarmohammadi (Tehran,IR), M M Ansari-Ramandi (Birjand,IR), S Beikmohammadi (Tehran,IR), B H Hosseiny Fahimi (Lubeck,DE), N Naderi (Tehran,IR)

Authors:
H Yarmohammadi1 , M M Ansari-Ramandi2 , S Beikmohammadi3 , B H Hosseiny Fahimi4 , N Naderi3 , 1Medical Students Research Committee, Shahed University - Tehran - Iran (Islamic Republic of) , 2Syed Mostafa Khomeini Hospital, Tabas, Birjand University of Medical Sciences - Birjand - Iran (Islamic Republic of) , 3Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences - Tehran - Iran (Islamic Republic of) , 4Department of Cardiology, Universitätsmedizin Schleswig-Holstein - Lubeck - Germany ,

Citation:

Introduction: Heart failure is a prevalent morbid disease with a high economic burden for the healthcare system. There has been data supporting that allopurinol, a xanthine oxidase inhibitor, can improve the endothelial dysfunction, cardiac function, and quality of life in these patients.

Purpose: Review allopurinol efficacy and safety in heart failure patients to shed light on improvement in different outcomes.

Methods: Electronic search in Medline, Scopus, Web of Science and Google Scholar was conducted for mesh terms of "allopurinol" and "heart failure" and updated on 11/1/2019 for the last time. Only articles in English or Persian language and only human interventional studies about allopurinol efficacy or safety in heart failure patients were eligible for inclusion. The title, abstract and full text of search results were screened after excluding duplicates, letters, congress abstracts, and reviews and then articles assessed for their risk of bias according to Quadas2. Included 17 articles were used to extract data about treatment outcomes. Screening, data extraction, and risk of bias evaluation were cross-checked with a second author, based on PRISMA guideline.

Results: Most of the included articles were randomised clinical trials. About half of the studies were mainly focused on cardiac function. The other main focus of the studies were endothelial dysfunction and cardiac biomarkers. Only one study focused on cardiac rhythm in heart failure patients. The majority of the included patients had left ventricle ejection fraction (LVEF) of less than 40%. The most administered allopurinol dose was 300 mg daily. There were many outcomes reported in the studies which were categorized into three groups (Imaging, laboratory data, and others). Flow-mediated vasodilation and LVEF, uric acid level and N terminal-pro B type natriuretic peptide (N terminal-pro BNP), New York heart association functional class and 6-minute walk test were the most frequently measured parameters in imaging, laboratory and other outcomes respectively. Out of the studies, most of them showed significant improvement in the above parameters. Two studies evaluated the quality of life from which one reported significant improvement. Only one study used strain imaging for evaluation of cardiac function which showed significant improvement. Two studies showed no significant improvement of N terminal-pro BNP and one of them which was also using imaging did not show improvement in LVEF. In a study evaluating two doses of Allopurinol, the higher 600 mg daily dose was significantly better in improving the outcomes. Allopurinol was well tolerated and the most reported adverse effect was skin rash.

Conclusion:

Although there is evidence that allopurinol significantly improves endothelial dysfunction, cardiac biomarkers, and function, there is a need for more high quality randomised controlled trials to give insight about which patients benefit most from its use.

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