Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort
Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort
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DOI：
10.1186/s13075-018-1559-2
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发表时间：
2018-03-22
影响因子：
4.9
通讯作者：
Andres, Mariano
中科院分区：
文献类型：
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作者：
Ranieri, Laura;Contero, Carolina;Andres, Mariano
背景资料：利尿剂与痛风的反应受损和难治性相关，但这种作用是否仍然存在于新的降尿酸药物（ULD）和治疗目标策略中尚不清楚。本研究的目的是评估利尿剂对ULD反应的影响，在patientswith gute.Methods：这是一个回顾性分析的起始队列。根据规定的ULD类型对参与者进行分类。我们分析了ULD的最大剂量（主要结局变量）、血清尿酸（SU）降低以及不同SU目标（6 mg/dL、5 mg/dL和4 mg/dL）的实现情况，根据ULD处方类型和利尿剂（袢和/或噻嗪）的使用情况。我们调整混杂因素使用多元线性回归analysis.Results：我们包括245例患者：208别嘌呤醇治疗（66利尿剂，31.7%），35与非布司他（19利尿剂，57.6%），和2与苯溴马隆。别嘌呤醇加利尿剂亚组中达到SU水平低于5 mg/dL的受试者显著较少，但我们发现与利尿剂相关的SU目标没有其他显著差异。关于最大ULD剂量，简单线性回归表明与利尿剂呈反比关系（β =-0.125，p = 0.073），但这在多变量分析中并不成立（β =-0.125，p = 0.073）。47，p = 0.833）。与非布司他无相关性（β =-0.116，p = 0.514）。结论：利尿剂似乎对治疗痛风无显著影响。
Background: Diuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout.Methods: This was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5 mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis.Results: We included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = -0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = -0. 47, p = 0.833). There was no association with febuxostat (beta = -0.116, p = 0.514).Conclusion: Diuretics do not appear to have a significant impact on managing gout.