递增降尿酸药物预防和减少痛风急性发作的疗效及安全性评估

Efficacy and Safety Evaluation of Increasing Uric Acid Lowering Drugs to Prevent and Reduce Acute Gout Attacks

目的研究在起始降尿酸阶段逐步递增降尿酸药物非布司他剂量预防和减少痛风急性发作的疗效及安全性。方法选取2018年8月-2020年6月我院门诊或住院的痛风患者102例,随机分为试验组(54例)和对照组(48例)。对照组采用非布司他(40 mg/d)联合秋水仙碱(0.5mg/d,12周)治疗,试验组采用递增非布司他治疗,剂量从10 mg/d(4周)、20 mg/d(4周)到40 mg/d(4周)。比较两组治疗12周时痛风急性发作情况、血清尿酸达标率及不良反应发生情况。结果治疗12周时试验组和对照组痛风急性发作频率分别为20.37%、18.75%,差异无统计学意义(P>0.05);试验组和对照组血清尿酸达标率分别为81.48%、83.33%,差异无统计学意义(P>0.05);治疗期间,两组均无严重不良事件发生。结论逐步递增降尿酸药物非布司他剂量可有效预防痛风急性发作,可能成为低剂量秋水仙碱预防急性发作的有效替代方案。

Objectives To study the efficacy and safety of gradually increasing the dose of febuxostat in the initial stage of uric acid lowering to prevent and reduce the acute attack of gout.Methods A total of 102 outpatients or inpatients with gout in our hospital from August 2018 to June 2020 were selected and randomly divided into an experimental group(54 cases)and a control group(48 cases).The control group was treated with febuxostat(40 mg/d)combined with colchicine(0.5 mg/d,12 weeks).The experimental group was treated with increasing doses of febuxostat from 10 mg/d(4 weeks),20 mg/d(4 weeks)to 40 mg/d(4 weeks).The acute attack of gout,serum uric acid compliance rate and adverse reactions were compared between the two groups at 12 weeks of treatment.Results At 12 weeks of treatment,the incidence of acute gout attack in the experimental group and the control group was 20.37%and 18.75%,respectively,and the difference was not statistically significant(P>0.05).The serum uric acid compliance rates of the experimental group and the control group were 81.48%and 83.33%,respectively,and the difference was not statistically significant(P>0.05).During the treatment,no serious adverse events occurred in both groups.Conclusion The gradually increasing dose of uric acid-lowering drug febuxostat can effectively prevent the acute attack of gout,which may become an effective alternative to low-dose colchicine to prevent acute attack.