Effectivity and safety profile of oxalate decarboxylase in hyperoxaluria patient: A meta-analysis and systematic review

Introduction: The high incidence of urinary stones leads to many related medical issues and substantial financial burdens. In addition to treatment interventions, executing preventive measures is crucial in reducing the likelihood of kidney stone recurrence. Oxalate decarboxylase is now being developed as a preventive measure for treating hyperoxaluria, a risk factor for stone formation. This study aims to evaluate the efficacy and safety of oxalate decarboxylase in treating hyperoxaluria. Methods:A comprehensive review of the existing literature was performed by conducting a systematic search across various databases, including Cochrane Library, Google Scholar, PubMed, and Embase. The mean difference (MD) of 24-hour urinary oxalate excretion from baseline to treatment was assessed in each study. Cochrane Collaboration’s Review Manager 5.4.1 software was used for statistical analysis, and RoB 2 tools were used for bias risk assessment. Result: Five studies that satisfied the specified criteria were included in the analysis, 3 of which were analyzed for meta-analysis data, while the other for systematic review. Meta-analysis showed that oxalate decarboxylase had a statistically significant efficacy compared to placebo in reducing oxaluria with MD of 9,72 mg/day (95% CI 7,43 to 12,10). Regarding safety, there is not much difference in the number of complications between oxalate decarboxylase and placebo, with only one study reporting a serious adverse event (SAE) of sacral radiculopathy in the intervention group. Conclusion: Oxalate decarboxylase is a potential and promising alternative treatment for reducing urinary oxalate levels in hyperoxaluria patients. Therefore, it can be regarded as a viable choice in pharmacological treatment for preventing the occurrence of oxalate stones in patients in the future.