From the Guidelines
Asymptomatic hyperuricemia in Filipino patients should not be treated with pharmacological urate-lowering therapy (ULT) unless specific risk factors are present, such as serum uric acid levels exceeding 9 mg/dL, comorbid moderate-to-severe chronic kidney disease (CKD), or a history of urolithiasis, as the benefits of treatment do not outweigh the potential risks for the majority of patients 1.
When considering treatment, the following factors should be taken into account:
- Serum uric acid levels: Treatment may be considered if levels exceed 9 mg/dL, as patients with markedly elevated SU concentrations are more likely to experience gout progression 1.
- Comorbidities: Patients with moderate-to-severe CKD (stage ≥3) may benefit from ULT, as there is a higher likelihood of gout progression and development of clinical tophi in this population 1.
- History of urolithiasis: Allopurinol and febuxostat may provide benefit in reducing the risk of stone-related events in patients with a history of urolithiasis 1.
Lifestyle modifications are essential for all patients with asymptomatic hyperuricemia, including:
- Limiting alcohol consumption
- Reducing intake of purine-rich foods (organ meats, shellfish, red meat)
- Maintaining adequate hydration
- Achieving a healthy weight
- Controlling comorbidities like hypertension and diabetes
The rationale for selective treatment is supported by studies demonstrating that the development of incident gout is low in patients with asymptomatic hyperuricemia, and that the benefits of ULT may not outweigh the potential treatment costs or risks for the large number of patients unlikely to progress to gout 1. Regular monitoring of uric acid levels every 6-12 months is recommended for asymptomatic patients not receiving pharmacological treatment.
From the FDA Drug Label
THIS IS NOT AN INNOCUOUS DRUG. IT IS NOT RECOMMENDED FOR THE TREATMENT OF ASYMPTOMATIC HYPERURICEMIA. The FDA drug label does not provide guidance on when to treat asymptomatic hyperuricemia in Filipino patients, but it clearly states that allopurinol and sulfinpyrazone are not recommended for this condition 2 3.
- The labels recommend treatment for patients with signs and symptoms of primary or secondary gout, leukemia, lymphoma, and malignancies, or recurrent calcium oxalate calculi.
- Asymptomatic hyperuricemia is not an indicated use for these medications. The decision to treat should be based on individual patient assessment, considering the potential benefits and risks.
From the Research
Treatment of Asymptomatic Hyperuricemia in Filipino Patients
- The treatment of asymptomatic hyperuricemia in Filipino patients is not recommended nor excluded by current guidelines 4.
- Treatment may be considered in patients with very high levels of uric acid or those at risk of complications, such as those with a personal or strong family history of gout, urolithiasis, or uric acid nephropathy 5.
- In Filipino patients, hyperuricemia may be caused by genetic factors, environmental stress, and dietary changes, and can be managed with urate-lowering agents such as allopurinol 6.
Considerations for Treatment
- Urine sediment analysis and musculoskeletal ultrasound may be used to guide treatment decisions in asymptomatic hyperuricemia 4.
- Trends in creatinine, proteinuria, and serum urate levels should also be monitored 4.
- The presence of urate crystals in the urine sediment and/or signs of asymptomatic articular damage by urates may indicate the need for treatment 4.
Management of Hyperuricemia in Filipino Patients with Chronic Kidney Disease
- Uric acid is a toxin retained with advancing kidney disease, and clinical manifestations of hyperuricemia include gout and systemic inflammation 7.
- Effective management of gout and hyperuricemia is crucial in patients with chronic kidney disease, and a team approach to gout management is recommended 7.
Cardiovascular Considerations
- Asymptomatic hyperuricemia is associated with an increased risk of cardiovascular events, but the use of direct-acting urate-lowering agents in asymptomatic hyperuricemia associated with cardiovascular diseases does not warrant a clear benefit 8.
- Addressing cardiovascular issues with guideline-recommended therapies may lower uric acid and reduce the occurrence of cardiovascular events 8.