Am J Kidney Dis:非布索坦治疗3期CKD和无症状高尿酸血症患者的疗效

2018-09-10 xing.T MedSci原创

由此可见,与安慰剂相比,非布索坦治疗并未减缓3期CKD和无症状高尿酸血症患者肾功能的下降。

流行病学和临床研究表明降尿酸治疗可能会减缓慢性肾病(CKD)的进展。但是,缺乏明确的证据。

近日,肾脏病领域权威杂志Am J Kidney Dis上发表了一篇研究文章,该研究为一项随机、双盲、安慰剂对照试验。参与者为日本55家医疗机构的467名患有3期CKD和无症状高尿酸血症的患者。参与者以1:1的比例随机分配接受非布索坦或安慰剂治疗108周。该研究的主要终点是估计的肾小球滤过率(eGFR)斜率(以mL/min/1.73m2/年)。次要终点包括随访24、48、72和108周时eGFR和血清尿酸水平的变化以及血清肌酐水平加倍或开始透析治疗。

在随机分配的443名患者中,219名和222名分别分配到非布索坦和安慰剂组,并纳入分析。非布索坦(0.23±5.26 mL/min/1.73 m2/年)和安慰剂(-0.47±4.48 mL/min/1.73 m2/年)组之间的平均eGFR斜率无显著差异(差异为0.70; 95%CI为-0.21至1.62; P=0.1)。亚组分析显示非布索坦在无蛋白尿的患者中有显著的益处(P=0.005),血清肌酐浓度低于中位数(P=0.009)。非布索坦组(0.91%)的痛风性关节炎发生率显著低于安慰剂组(5.86%)(P=0.007)。没有观察到非布索坦特异性的不良事件。

由此可见,与安慰剂相比,非布索坦治疗并未减缓3期CKD和无症状高尿酸血症患者肾功能的下降。

原始出处:

Kenjiro Kimura,et al. Febuxostat Therapy for Patients With Stage 3 CKD and Asymptomatic Hyperuricemia: A Randomized Trial. Am J Kidney Dis.2018. https://www.ajkd.org/article/S0272-6386(18)30834-5/fulltext

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    2018-12-20 guoyibin
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objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102342, encryptionId=f915102342ea, topicName=高尿酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05f17331078, createdName=ms622625817193301, createdTime=Tue Sep 11 22:38:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485015, encodeId=81bd1485015b3, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Tue Sep 11 22:38:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), 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GetPortalCommentsPageByObjectIdResponse(id=344408, encodeId=c2123444080e, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Mon Sep 10 21:25:49 CST 2018, time=2018-09-10, status=1, ipAttribution=)]
  5. 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objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102342, encryptionId=f915102342ea, topicName=高尿酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05f17331078, createdName=ms622625817193301, createdTime=Tue Sep 11 22:38:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485015, encodeId=81bd1485015b3, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Tue Sep 11 22:38:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), 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GetPortalCommentsPageByObjectIdResponse(id=344408, encodeId=c2123444080e, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Mon Sep 10 21:25:49 CST 2018, time=2018-09-10, status=1, ipAttribution=)]
  6. 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GetPortalCommentsPageByObjectIdResponse(id=344408, encodeId=c2123444080e, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Mon Sep 10 21:25:49 CST 2018, time=2018-09-10, status=1, ipAttribution=)]
  7. 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GetPortalCommentsPageByObjectIdResponse(id=344408, encodeId=c2123444080e, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Mon Sep 10 21:25:49 CST 2018, time=2018-09-10, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1778722, encodeId=4dd41e78722d0, content=<a href='/topic/show?id=227d128885' target=_blank style='color:#2F92EE;'>#3期CKD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1288, encryptionId=227d128885, topicName=3期CKD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Dec 20 06:38:00 CST 2018, time=2018-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779098, encodeId=d8c51e7909851, content=<a href='/topic/show?id=227d128885' target=_blank style='color:#2F92EE;'>#3期CKD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1288, encryptionId=227d128885, topicName=3期CKD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, 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GetPortalCommentsPageByObjectIdResponse(id=1603123, encodeId=c488160312395, content=<a href='/topic/show?id=81b91049067' target=_blank style='color:#2F92EE;'>#kidney#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10490, encryptionId=81b91049067, topicName=kidney)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c36e18990621, createdName=gwc389, createdTime=Tue Sep 11 22:38:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344454, encodeId=80ed344454f8, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6d551998554, createdName=1e1c07bdm01(暂无匿称), createdTime=Tue Sep 11 06:15:42 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=344408, encodeId=c2123444080e, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Mon Sep 10 21:25:49 CST 2018, time=2018-09-10, status=1, ipAttribution=)]
    2018-09-11 gwc389
  9. [GetPortalCommentsPageByObjectIdResponse(id=1778722, encodeId=4dd41e78722d0, content=<a href='/topic/show?id=227d128885' target=_blank style='color:#2F92EE;'>#3期CKD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1288, encryptionId=227d128885, topicName=3期CKD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Dec 20 06:38:00 CST 2018, time=2018-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779098, encodeId=d8c51e7909851, content=<a href='/topic/show?id=227d128885' target=_blank style='color:#2F92EE;'>#3期CKD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1288, encryptionId=227d128885, topicName=3期CKD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, 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  10. 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objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102342, encryptionId=f915102342ea, topicName=高尿酸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=05f17331078, createdName=ms622625817193301, createdTime=Tue Sep 11 22:38:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485015, encodeId=81bd1485015b3, content=<a href='/topic/show?id=4bbe5902ed2' target=_blank style='color:#2F92EE;'>#无症状#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59027, encryptionId=4bbe5902ed2, topicName=无症状)], attachment=null, authenticateStatus=null, createdAvatar=Bioon/avatar/20180429/70baad2aa5a046c5aa2914d262de7d37.jpg, createdBy=bd077990475, createdName=12498da4m34(暂无昵称), createdTime=Tue Sep 11 22:38:00 CST 2018, time=2018-09-11, status=1, ipAttribution=), 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GetPortalCommentsPageByObjectIdResponse(id=344408, encodeId=c2123444080e, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Mon Sep 10 21:25:49 CST 2018, time=2018-09-10, status=1, ipAttribution=)]
    2018-09-10 惠映实验室

    学习了,谢谢分享。

    0

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研究认为对于存在心血管疾病的痛风患者,服用非布索坦或别嘌呤醇对患者心血管不良事件的影响差异不显著,但非布索坦导致患者全因死亡以及心血管死亡风险增加

Ann Rheum Dis:降尿酸疗法初期,非布索坦逐步加量与秋水仙碱预防痛风发作的作用相当

这项研究数据表明,与单独使用固定剂量的非布索坦相比,非布索坦逐步加量和低剂量的秋水仙碱可有效减少痛风发作。