Modern pleotropic drugs as an alternative to classical urate-lowering therapy in the treatment of Asymptomatic Hyperuricemia and gout
https://doi.org/10.31146/1682-8658-ecg-235-3-217-225
Abstract
Although most patients with hyperuricemia are never destined to experience an attack of gout or symptoms of urolithiasis, elevated uric acid levels are now a recognized risk factor for cardiovascular morbidity and outcomes. From these perspectives, lowering uric acid in the blood is recognized as desirable. The use of classical urate-lowering drugs is consistent with a paradigm in which each risk factor to be corrected is contrasted with a drug with the desired direction of effect. The extended use in patients with asymptomatic hyperuricemia of classical xanthine oxidase inhibitors, which are highly effective in reducing blood uric acid, is associated with a number of negative consequences, including potentially severe morbidity, the need for dose selection and monitoring, and decreased adherence to agents proven to be effective as cardio- and renoprotective agents. New data on the role of the inflammasome, a complex of intracellular proteins whose activation ensures the formation of interleukins IL-1β, IL-18, allow us to regard hyperuricemia as only one of the triggers of inflammation. This knowledge allows us to emphasize in the problem of renal and cardiovascular diseases associated with hyperuricemia the ability of known cardiac drugs (statins and sodium-glucose transporter type 2 inhibitors - INGLT-2) to reduce the activity of NLRP3 inflammasome, achieving optimal therapeutic efficacy. This strategy seems to be the only correct one in patients with asymptomatic hyperuricemia, also applicable in gout, reducing the need for classical urates-lowering therapy, preventing the inevitable polypharmacy.
About the Authors
P. A. Lebedev
Samara State Medical University
Russian Federation
Russian Federation
E. V. Paranina
Samara State Medical University
Russian Federation
Russian Federation
S. P. Lebedeva
Samara State Medical University
Russian Federation
Russian Federation
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For citations:
Lebedev P.A., Paranina E.V., Lebedeva S.P. Modern pleotropic drugs as an alternative to classical urate-lowering therapy in the treatment of Asymptomatic Hyperuricemia and gout. Experimental and Clinical Gastroenterology. 2025;(3):217-225. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-235-3-217-225
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