Arthritis Rheumatol:李长贵教授团队研究发现低剂量苯溴马隆能有效降低痛风人群的尿酸水平

2022-08-05 MedSci原创 MedSci原创

痛风患者高尿酸血症的主要机制是肾脏尿酸排泄不足,但标准的降尿酸治疗(ULT)建议是黄嘌呤氧化酶抑制(XOI),这有助于降低受影响的人的血尿酸水平,而不考虑高尿酸血症的原因。然而,《关节炎与风湿病学》杂

痛风患者高尿酸血症的主要机制是肾脏尿酸排泄不足,但标准的降尿酸治疗(ULT)建议是黄嘌呤氧化酶抑制(XOI),这有助于降低受影响的人的血尿酸水平,而不考虑高尿酸血症的原因。然而,《关节炎与风湿病学》杂志报道的一项新的临床试验表明,一种不太受到关注的药物苯溴马隆,在低剂量时效果相当不错,优于低剂量非布司他。

这项研究来自于青岛大学附属医院痛风门诊李长贵教授团队,研究人员进行了一项前瞻性、随机、单中心、开放标签的试验,对象是痛风患者和肾脏尿酸排泄不足的男性(定义为尿酸排泄分数 <5.5% 和尿酸排泄≤600 mg/天/1.73m2)。将 196 名参与者随机分配到每天 25 毫克低剂量苯溴马隆 (LDBen) 或每天 20 毫克低剂量非布司他 (LDFeb) 组,持续 12 周。所有参与者每天都接受口服碳酸氢钠碱化尿液。主要终点是实现血清尿酸 (SU) 目标 <6 mg/dL 的比率。主要疗效终点是治疗第 12 周达到目标 SU<6.0mg/dL 的比率。 次要疗效结果是达到目标 SU<5.0 mg/dL 的比率、SU 的变化(ΔSU%、(基线 SU-vis it SU)/基线 SU)以及其他实验室参数的变化,包括 SU、FBG、TC 、TG、AST、ALT、Cr、eGFR。

结果表明,与 LDFeb 相比,LDBen 组更多的受试者达到了血清尿酸目标(61% 对 32%,P<0.001)。包括痛风发作和尿石症在内的不良事件在各组之间没有差异,除了 LDFeb 组的转氨酶升高更多(LDBen 4% 对 LDFeb 15%,P=0.008)。与LDFeb相比,在相对年轻和健康的肾性尿酸不足型痛风患者中,LDBen具有优越的降尿酸作用和相似的安全性。

研究者认为,低剂量的苯溴马隆可能值得更多考虑,作为一种安全和有效的疗法来实现控制痛风的血尿酸目标。

关于李长贵

李长贵, 男,医学博士,主任医师,博士研究生导师,博士后指导导师,青岛大学医学院附属医院代谢病科主任,青岛市常见病重点实验室----痛风病实验室主任。 现任亚太痛风联盟(APGC)联合主席,中华医学会内分泌学会高尿酸学组执行组长,海峡两岸医药卫生交流协会风湿免疫病学专业委员会高级顾问兼痛风学组副组长,中国老年学会老年医学委员会常委兼高尿酸与痛风专业委员会主任委员,山东省泰山学者,山东省痛风病临床医学中心主任,青岛大学代谢病研究院院长。

原始出处:

Yan F, Xue X, Lu J, Dalbeth N, Qi H, Yu Q, Wang C, Sun M, Cui L, Liu Z, He Y, Yuan X, Chen Y, Cheng X, Ma L, Li H, Ji A, Hu S, Ran Z, Terkeltaub R, Li C.Superiority of low-dose benzbromarone to low-dose febuxostat in a prospective, randomized comparative effectiveness trial in gout patients with renal uric acid underexcretion.Arthritis Rheumatol . 2022 Jul 7. doi: 10.1002/art.42266

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    2022-08-06 仁医06
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咖啡可以减少痛风风险,这是毋庸置疑,但是作用机制仍有谜团尚待揭开。

尿酸真的是一无是处吗?关于你所不知道的尿酸作用

尿酸,存在即合理,可不是越低越好。