Guideline development for the management of gout: role of combination therapy with a focus on lesinurad.
Guideline development for the management of gout: role of combination therapy with a focus on lesinurad.
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DOI：
10.2147/dddt.s97959
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Day R
中科院分区：
文献类型：
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作者：
Jones G;Panova E;Day R
本综述的目的是总结联合治疗以达到痛风患者血清尿酸盐（SUA）目标水平的证据。在这个总体目标中，第二个目标是评估一种新的尿酸排泄剂lesinurad的证据，它抑制尿酸盐在肾脏中的转运。总之，这篇综述表明，有许多方法可以接近别嘌呤醇（APL）单药治疗不能达到目标血清尿酸盐的患者。这些措施包括更高剂量的APL高达600-800 mg/d，转换为非布司他，或添加尿酸。对于后一种选择，有苯溴马隆、丙磺舒和来西奴拉的受控支持性证据。所有选项在成功率方面似乎相似，因此选项的选择取决于医生和患者的选择、成本、经验和证据基础的强度。增加APL的剂量是最便宜的选择，而非布司他始终上级APL的标准剂量。对于lesinurad来说，最强有力的证据是关于排尿酸的选择，因为其他药物的试验要么不存在，要么基于小型单中心试验。建议应扩大指南，以考虑所有这些循证选择在APL不充分的反应并不罕见的发生。
The aim of this review was to summarize the evidence for combination therapy to achieve serum urate (SUA) target levels in gout. Within this overarching aim, a second aim was to evaluate the evidence for a new uricosuric agent lesinurad, which inhibits urate transport in the kidney. In summary, this review indicates that there are a number of ways to approach patients who do not achieve a target serum urate with allopurinol (APL) monotherapy. These include higher doses of APL up to 600–800 mg/d, switching to febuxostat, or adding in a uricosuric. For the latter option, controlled supporting evidence is available for benzbromarone, probenecid, and lesinurad. All options appear similar in terms of success rates, so the choice of option comes down to physician and patient choice, cost, experience, and strength of the evidence base. Increasing the dose of APL is the cheapest option, while febuxostat is consistently superior to standard doses of APL. The strongest evidence for the uricosuric option is available for lesinurad as trials of other agents are either nonexistent or based on small single-centre trials. It is suggested that guidelines should be expanded to consider all of these evidence-based options in the not-uncommon occurrence of APL inadequate response.