Document Detail

Prednisone in Uric Acid lowering in Symptomatic Heart Failure Patients With Hyperuricemia (PUSH-PATH) study.
MedLine Citation:
PMID:  23395281     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chronic drug interactions that exist between symptomatic congestive heart failure (CHF) therapy and pharmacologic agents used for hyperuricemia and gout are a challenging problem in clinical practice. Recent observational studies showed that prednisone can induce a potent diuresis and lower serum uric acid concentration (SUA) in CHF. We therefore designed a randomized study to compare the effect of prednisone with allopurinol on SUA in symptomatic CHF patients with hyperuricemia.
METHODS: Thirty-four symptomatic CHF participants with hyperuricemia (≥ 565 μmol/L) were randomized to receive prednisone (1 mg/kg/d, orally) or allopurinol (100 mg, thrice daily, orally) for 4 weeks. The primary outcome measure was change from baseline in SUA. The secondary outcome measures were change from baseline in serum creatinine levels, estimated glomerular filtration rate, daily urine output, body weight, N-terminal pro-B-type natriuretic peptide levels, physician-assessed global clinical status, and New York Heart Association functional class.
RESULTS: Both prednisone and allopurinol greatly lowered SUA rapidly. The overall SUA-lowering effect did not differ between treatment groups during the study period (P = 0.48, 2-way repeated measures analysis of variance). However, prednisone increased estimated glomerular filtration rate and daily urine output, and lowered body weights and N-terminal pro-B-type natriuretic peptide. Consequently, participants treated with prednisone had an improvement in clinical status.
CONCLUSIONS: The study showed that the SUA-lowering effect of prednisone and allopurinol is similar in symptomatic CHF patients. Prednisone might be useful for short-term SUA-lowering in CHF patients with hyperuricemia.
Chao Liu; Qingzhen Zhao; Yuzhi Zhen; Yanqiu Gao; Li Tian; Le Wang; Lishuang Ji; Gang Liu; Zhenguo Ji; Kunshen Liu
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2013-02-06
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  29     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-08-26     Completed Date:  2013-11-19     Revised Date:  2014-04-07    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  1048-54     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Allopurinol / adverse effects,  therapeutic use*
Creatinine / blood
Dyspnea / prevention & control
Glomerular Filtration Rate / drug effects
Glucocorticoids / adverse effects,  therapeutic use*
Gout Suppressants / adverse effects,  therapeutic use*
Heart Failure / blood,  drug therapy*,  urine
Hyperuricemia / blood,  drug therapy*,  urine
Middle Aged
Natriuretic Peptide, Brain / blood,  drug effects
Peptide Fragments / blood,  drug effects
Prednisone / adverse effects,  therapeutic use*
Prospective Studies
Severity of Illness Index
Treatment Outcome
Uric Acid / blood*
Reg. No./Substance:
0/Glucocorticoids; 0/Gout Suppressants; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; 268B43MJ25/Uric Acid; 63CZ7GJN5I/Allopurinol; AYI8EX34EU/Creatinine; VB0R961HZT/Prednisone
Comment In:
Can J Cardiol. 2013 Sep;29(9):1021-3   [PMID:  23535276 ]
Can J Cardiol. 2014 Mar;30(3):376.e3   [PMID:  23831010 ]
Can J Cardiol. 2014 Mar;30(3):376.e1   [PMID:  23831009 ]

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