摘要
目的了解痛风患者初始降尿酸治疗过程中,通过逐步增加口服非布司他剂量的方法是否与秋水仙碱预防痛风发作同样有效。明确通过逐步增加口服非布司他剂量的方法是否可以达到血尿酸达标控制的效果。方法在这项前瞻性、多中心、随机开放对照研究中,患者随机数字表法分为A组(非布司他剂量从10 mg/d逐步增加到40 mg/d)、B组(固定剂量非布司他剂量40 mg/d+秋水仙碱0.5 mg/d)和C组(固定剂量非布司他剂量40 mg/d),观察24周。每4周进行1次随访。痛风发作时首选NSAIDs控制症状。计量资料组间比较采用单因素方差分析,计数资料比较采用χ2检验。结果共276例患者被纳入研究,253例患者接受治疗。211例患者完成了全部的治疗与随访。在接受治疗的患者中,A组共有21例出现了37次痛风发作,B组共有20例出现35次发作,C组共有26例出现44次发作。痛风发作率A组21/84(25.0%),B组20/85(23.5%)2组之间差异无统计学意义(χ^2=0.050,P=0.824)。C组痛风发作率26/42(61.9%),高于A组与B组,差异有统计学意义(χ^2=22.040,P<0.01)。A组4周和8周血尿酸达标率明显低于B组和C组,差异有统计学意义(4周时χ^2=42.743,P<0.01;8周时χ^2=26.351,P<0.01),12周后3组间差异无统计学意义(12周时χ^2=0.452,P=0.798;24周时χ^2=0.219,P=0.896)。结论逐步增加非布司他剂量和小剂量秋水仙碱预防有效地减少了痛风发作。逐步增加非布司他剂量可能是在初始降尿酸治疗期间替代小剂量秋水仙碱预防痛风发作的一种有效的替代方法。
Objective To investigate whether febuxostat with stepwise dose increase is as useful as colchicine prophylaxis in comparison with febuxostat with no dose titration when initial introduction of urate-lowering therapy in patients with gout.And to determine the effect of urate-lowering therapy in the treat to target by febuxostat with stepwise dose increase.Methods In this prospective,multicentre,randomized open-label comparative study,patients were randomized to group A(stepwise dose increase of febuxostat from 10 to 40 mg/d),group B(fixed-dose febuxostat 40 mg/d plus colchicine 0.5 mg/d)or group C(fixed-dosefebu-xostat 40 mg/d)and were followed-up for 24 weeks.Non-steroidal anti-inflammatory drug was used to control symptoms when acute flare occurred.Patients were follow-up every 4 weeks.The comparison between groups was made by single factor analysis of variance(ANOVA).χ^2 test was used to compare groups.Results A total of 276 patients were randomized,and 253 patients were treated.211 patients completed the study and were follow-up.Among the treated patients,gout flares were experienced by 12/84(25.0%)in group A,20/85(23.5%)in group B and 26/42(61.9%)in group C.There was no significant difference between group A and group B(χ2=0.050,P=0.824)in gout flares.There was significantly higher frequency in gout flares in group C than that in group A and group B(χ^2=22.040,P<0.01).The proportion of patients reaching the target of urate-lowering therapy in group A at 4 and 8 weeks was significantly lower than that in group B and C.And there was no significant difference among the three groups after 12 weeks.Conclusion Stepwise dose increase of febuxostat and low-dose colchicine has the same prophylaxis effectiveness in reducing gout flares but are more effective in prevent acute flare when compared with fixed-dose febuxostat alone.Stepwise dose increase of febuxostat may be an effective alternative to low-dose colchicine prophylaxis during the introduction of urate-lowering therapy.
作者
王贵红
夏江莉
周胜利
左婷
李然
Wang Guihong;Xia Jiangli;Zhou Shengli;Zuo Ting;Li Ran(Department of Rheumatology and Immunology,Anqing Hospital of Anhui Medical University,Anqing 246003,China;Department of Rheumatology and Immunology,Chaohu Hospital of Anhui Medical University,Hefei 230000,China;Department of Rheumatology and Immunology,Hefei Hospital of Anhui Medical University,Hefei 230000,China)
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2020年第6期388-391,共4页
Chinese Journal of Rheumatology
基金
安徽省安庆市医疗卫生科技计划项目(2018Z2003)。
关键词
痛风
尿酸
非布司他
Gout
Uric acid
Febuxostat
