非布司他治疗高尿酸血症有效性及安全性的Meta分析

Efficacy and Tolerability of Febuxostat in Hyperuricemic Patients:A Meta-Analysis

目的系统评价非布司他对比别嘌醇治疗高尿酸血症的有效性和安全性。方法检索PubMed、Cochrane图书馆、EMBASE、CNKI、万方、维普等数据库,搜集非布司他和别嘌醇治疗高尿酸血症的随机对照试验,检索时限为建库至2017年2月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan5.3软件进行Meta分析。结果纳入23项随机对照试验,共计8 530个患者,Meta分析结果显示:在降尿酸效果方面,非布司他40 mg/d对比别嘌醇差异有统计学意义(风险比1.14,95%可信区间1.05～1.23,P=0.001),非布司他80 mg/d(风险比1.72,95%可信区间1.61～1.83,P<0.000 01)和120 mg/d(风险比2.04,95%可信区间1.85～2.26,P<0.000 01)都比别嘌醇更有效。随着非布司他剂量增加,其降尿酸能力也增加。在安全性方面,别嘌醇更易发生皮疹(比值比0.65,95%可信区间0.47～0.88,P<0.006),其他不良反应无明显差异。结论非布司他具有良好的降低血清尿酸作用,且皮疹发生率比别嘌醇低。

Objective To evaluate efficacy and safety of Febuxostat in hyperuricemic patients compared with Allopurinol by systematic review. Methods Electronic databases(PubMed,the Cochrane library,EMBASE,CNKI,Wanfang,CBM,ect)were searched for articles of all publication years(up to February 2017). According to the inclusion and exclusion criteria,tow reviewers independently selected articles,extracted data and evaluated quality. Randomized controlled trials(RCTs) were analyzed by meta-analysis. Results 23 RCTs were included. A significantly greater proportion of patients achieved the target serum urate level(sUA<6.0 mg/dL)at the final visit in the Febuxostat groups(40 mg/d:RR1.14,95%CI 1.05~1.23,P=0.001;80 mg/d:RR 1.72,95%CI 1.61~1.83,P<0.000 01;120 mg/d:RR 2.04,95%CI 1.85~2.26,P<0.000 01)compared with the Allopurinol groups. Conclusion Compared with Allopurinol(100~300 mg/d),Febuxostat(80~240 mg/d)showed more effective outcome and may reduce the incidence of rash.