Ann Rheum Dis:别嘌呤剂量升级使痛风患者血清尿酸盐达标是否安全有效?

2017-09-06 选题审校:门鹏 编辑:贾朝娟 环球医学

抗痛风治疗的首选药为别嘌呤。2017年9月,发表在《Ann Rheum Dis》的一项研究显示,高于基于-CrCL的别嘌呤剂量能有效降低大多数痛风患者的SU以达标。别嘌呤剂量升级能被很好地耐受。目的:采用治疗-达标血清尿酸盐(SU)方法,考察别嘌呤剂量升级的有效性和安全性。方法:开展了一项随机、对照、平行组、对比临床试验。接受基于肌酐清除率(CrCL)的别嘌呤剂量≥1个月和SU≥6 mg/dL的痛

抗痛风治疗的首选药为别嘌呤。2017年9月,发表在《Ann Rheum Dis》的一项研究显示,高于基于-CrCL的别嘌呤剂量能有效降低大多数痛风患者的SU以达标。别嘌呤剂量升级能被很好地耐受。

目的:采用治疗-达标血清尿酸盐(SU)方法,考察别嘌呤剂量升级的有效性和安全性。

方法:开展了一项随机、对照、平行组、对比临床试验。接受基于肌酐清除率(CrCL)的别嘌呤剂量≥1个月和SU≥6 mg/dL的痛风患者被招募。受试者被随机分配至持续目前剂量(对照)或别嘌呤剂量升级,持续12个月。在剂量升级组中,别嘌呤按月增加,直至SU<6 mg/dL。主要终点是SU和不良事件(AEs)降低。

结果:招募了183名受试者(93名对照,90名剂量升级)。基线时,平均(SD)尿酸盐是7.15(1.6)mg/dL,别嘌呤剂量是269 mg/日。52%的CrCL<60 mL/min。最后1次就诊时对照组的SU平均变化是-0.34 mg/dL,剂量升组组是-1.5 mg/dL(p<0.001),平均差是1.2 mg/dL(95%CI 0.67~1.5,p<0.001)。12个月时,对照组中32%和剂量升级组中69%的SU<6 mg/dL。在25名对照患者中有43例严重AEs,在22名剂量升级受试者中有35例事件。仅1名患者被认为可能与别嘌呤相关。5名对照患者和5名剂量升级受试者死亡;均被认为与别嘌呤无关。LFTs轻微升高在两组中常见,还注意到谷氨酰基转移酶(GGT)有少量的适量增加。随机分组的肾功能变化没有差异。

结论:高于基于-CrCL的别嘌呤剂量能有效降低大多数痛风患者的SU以达标。别嘌呤剂量升级能被很好地耐受。

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    2017-09-06 QFXL123456

    学习了.谢谢!

    0

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    2017-09-06 131****1460

    学习了受益匪浅.

    0