Effect of allopurinol on all-cause mortality in adults with incident gout: propensity score-matched landmark analysis
Effect of allopurinol on all-cause mortality in adults with incident gout: propensity score-matched landmark analysis
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DOI：
10.1093/rheumatology/kev246
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发表时间：
2015-12-01
期刊：
影响因子：
5.5
通讯作者：
Doherty, Michael
中科院分区：
文献类型：
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作者：
Kuo, Chang-Fu;Grainge, Matthew J.;Doherty, Michael
Objective.研究别嘌呤醇使用与痛风患者全因死亡率之间的关系。我们使用英国临床实践研究数据链接，比较了在暴露窗口（1年或3年）内接受别嘌呤醇治疗至少6个月的痛风患者与未接受别嘌呤醇治疗的患者的全因死亡率。地标分析用于解释不朽的时间偏倚，倾向评分匹配用于控制已知混杂因素的潜在影响。在确定的23332例痛风患者中，倾向评分匹配队列包括1016例在诊断后1年（标志日期）暴露于别嘌呤醇的患者和1016例别嘌呤醇非使用者。在里程碑日期后10年的中位随访期内，有437名别嘌呤醇使用者和443名别嘌呤醇非使用者在随访期间死亡。别嘌呤醇使用者和非使用者的全因死亡率风险相似（风险比0.99; 95%CI 0.87，1.12）。在3年的里程碑分析中，3519别嘌呤醇使用者（1280例死亡）与3519非使用者（1265例死亡）进行了比较。全因死亡的危险比为1.01（95%CI 0.92，1.09）。在英国初级保健环境中，对痛风患者人群进行的倾向评分匹配的里程碑分析发现，对全因死亡率的风险有中性影响。我们的研究为痛风患者在病程早期使用别嘌呤醇处方以预防慢性不受控制的高尿酸血症的不良后果提供了保证。然而，高于常用剂量的别嘌呤醇是否会影响死亡率仍有待确定。
Objective. To examine the association between allopurinol use and all-cause mortality for patients with incident gout.Methods. We compared all-cause mortality in incident gout patients who received allopurinol for at least 6 months within the exposure window (1 year or 3 years) with those who did not, using the UK Clinical Practice Research Data-link. Landmark analysis was used to account for immortal time bias and propensity score matching was used to control for potential effects of known confounders.Results. Of 23 332 incident gout patients identified, the propensity score-matched cohorts contained 1016 patients exposed to allopurinol on the date 1 year from diagnosis (landmark date) and 1016 allopurinol non-users. Over a median follow-up period of 10 years after the landmark date, there were 437 allopurinol users and 443 allopurinol non-users who died during follow-up. Allopurinol users and non-users had similar risk for all-cause mortality (hazard ratio 0.99; 95% CI 0.87, 1.12). In the 3-year landmark analysis, 3519 allopurinol users (1280 died) were compared with 3519 non-users (1265 died). The hazard ratio for all-cause mortality was 1.01 (95% CI 0.92, 1.09).Conclusion. This propensity score-matched landmark analysis in a population of incident gout patients in the UK primary care setting found a neutral effect on the risk of all-cause mortality. Our study provides reassurance about the prescription of allopurinol for gout patients early in their disease course to prevent untoward consequences of chronic uncontrolled hyperuricaemia. However, whether higher than the commonly used dose of allopurinol could influence mortality remains to be determined.