Comparison of persistence rates between allopurinol and febuxostat as first-line urate-lowering therapy in patients with gout: an 8-year retrospective cohort study
Comparison of persistence rates between allopurinol and febuxostat as first-line urate-lowering therapy in patients with gout: an 8-year retrospective cohort study
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DOI：
10.1007/s10067-020-05161-w
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发表时间：
2020-05-26
影响因子：
3.4
通讯作者：
Lee, Seung-Geun
中科院分区：
文献类型：
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作者：
Kim, Aran;Kim, Yunkyung;Lee, Seung-Geun
引言/目的黄嘌呤氧化酶抑制剂（XOI），如别嘌呤醇和非布司他的终身降尿酸治疗（AUG）是痛风治疗的基石。本研究旨在比较别嘌呤醇和非布司他在真实的实践中作为痛风患者一线药物的药物持久性。方法在这项回顾性队列研究中，我们评估了2011年12月至2018年11月在三级风湿病中心新启用别嘌呤醇或非布司他的602例痛风患者。持续性定义为从首次描述日期至XOI治疗结束或研究期结束（2019年11月）的持续时间。结果602例痛风患者中，平均年龄60.2岁，痛风石234例（38.9%）。分别有237例（39.3%）和365例（60.6%）患者开始使用别嘌呤醇和非布司他。在研究期间，282例（46.8%）患者停止服用XOI，最常见的原因是健康素养差（61.3%）。XOI的1年和5年持续率分别为67.2%和40.9%。在Kaplan-Meier分析中，别嘌呤醇的持续率显著低于非布司他（p < 0.001）。在多变量考克斯回归模型中，别嘌呤醇使用是停用XOI的显著风险因素（HR = 2.01，p < 0.001）。此外，痛风石的存在和症状持续时间< 24个月与较高的XOI戒断风险独立相关。结论：痛风患者中，XOI的长期持续性不佳，别嘌呤醇的持续性比非布司他差。
Introduction/objectives Lifelong urate-lowering therapy (ULT) with xanthine oxidase inhibitors (XOIs), such as allopurinol and febuxostat, is the cornerstone of gout treatment. This study aimed to compare drug persistence between allopurinol and febuxostat as first-line ULT in patients with gout in real practice. Method In this retrospective cohort study, we evaluated 602 patients with gout in whom allopurinol or febuxostat was newly initiated from December 2011 to November 2018 at a tertiary rheumatology centre. Persistence was defined as the duration from the first description date to the end of treatment with XOIs or the end of the study period (November 2019). Results Among the 602 gout patients, the mean age was 60.2 years and 234 (38.9%) patients had tophi. Allopurinol and febuxostat were started in 237 (39.3%) and 365 (60.6%) patients, respectively. During the study period, 282 (46.8%) patients stopped taking XOIs, and the most common reason for XOI withdrawal was poor health literacy (61.3%). The 1- and 5-year persistence rates of XOIs were 67.2% and 40.9%, respectively. In the Kaplan-Meier analysis, persistence rates of allopurinol were significantly lower than those of febuxostat (p < 0.001). In the multivariable Cox regression model, allopurinol use was a significant risk factor for discontinuation of XOIs (HR = 2.01, p < 0.001). In addition, the presence of tophi and symptom duration < 24 months was independently associated with a higher risk of XOI withdrawal. Conclusions Long-term persistence of XOIs was suboptimal, and allopurinol had worse persistence rates than febuxostat among patients with gout.