非布司他和别嘌醇治疗痛风有效性和安全性的Meta分析

Efficacy and safety of febuxostat versus allopurinol in the treatment of gout by Meta analysis

目的评价非布司他与别嘌醇治疗痛风的有效性和安全性。方法在Pub Med、Em Base、Cochrane图书馆、CNKI和CBM数据库中检索非布司他的随机对照试验(RCTs)。2名作者分别独立进行文献筛选、质量评价和数据提取,根据Cochrane系统评价的原理和方法,使用Cochrane协作网提供的Rev Man 5.2.7软件进行Meta分析。结果 Meta分析最终纳入5个RCTs。与别嘌醇相比,接受非布司他治疗的患者血清尿酸(s UA)水平更易于降低至6 mg·d L-1以下,且降幅明显高于对照组(P<0.05),但是,非布司他并未降低痛风的发作率。非布司他组的不良反应发生率低于别嘌醇组。结论虽然非布司他更容易将s UA降至6mg·d L-1以下,但没有证据表明非布司他预防痛风发作的效果优于别嘌醇,且非布司他价格昂贵,不应作为治疗慢性痛风的常规选择,除非患者合并肾功能不全。

Objective To evaluate the efficacy and safety of febuxostat compared to allopurinol for the treatment of gout.Methods Randomized controlled trials （ RCTs ） of febuxostat were retrieved from PubMed , EmBase , the Cochrane Library , CNKI and CBM databases.Two revie-wers independently selected studies , assessed study quality , and extrac-ted data.According to the principles and methods of Cochrane systematic reviews , the included RCTs were analyzed by the software RevMan 5.2.7 provided by the Cochrane collaboration .Results Five studies were ulti-mately included in the analysis.Patients receiving febuxostat were more likely to achieve a serum uric acid （ sUA） of 6 mg· dL-1 than allopurinol recipients .The decline from baseline in sUA levels was more obvious in febuxostat group than allopurinol （P〈0.05）.However, febuxostat did not reduce the risk of gout flares compared with allopurinol .Overall , the risk of adverse drugs reaction was lower in febuxostat recipients than allopuri -nol.Conclusions Although febuxostat demonstrated a higher likelihood of achieving a target sUA level of 〈6 mg· dL-1 , however , there was no evidence that febuxostat is better than allopurinol for preventing gout flare .Taken its higher cost into consideration , febuxostat should not be the rou-tine option for chronic gout , except for those patients with renal dysfunction.