Achieving Serum Urate Goal: A Comparative Effectiveness Study Between Allopurinol and Febuxostat
Achieving Serum Urate Goal: A Comparative Effectiveness Study Between Allopurinol and Febuxostat
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DOI：
10.3810/pgm.2014.03.2741
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发表时间：
2014-03-01
影响因子：
4.2
通讯作者：
Khanna, Puja
中科院分区：
文献类型：
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作者：
Hatoum, Hind;Khanna, Dinesh;Khanna, Puja
背景：在2012年美国风湿病学会指南中，非布索斯特被推荐为治疗痛风的2种一线降尿酸疗法(ULT)之一。几项疗效试验已经将非布索斯特与别嘌醇治疗进行了比较，但现实世界的比较数据有限。方法：我们比较了两种药物在6个月内(主要终点)内达到血尿酸(SUA)目标(6 mg/dL)的效果、影响达到目标可能性的因素，以及未能达到SUA水平而改用非布索他汀治疗的别嘌醇患者的结果。分析了来自通用电气电子病历数据库的新诊断痛风成人患者的数据，这些患者在2009年或之后开始使用别嘌醇或非布索坦进行治疗。使用了描述性统计、双变量分析和Logistic回归。结果：别嘌醇(n=17199)和非布索坦(n=1190)患者的平均+/-标准差(SD)年龄为63.7(+/-13.37)岁，大多数患者为男性和白人。在前6个月，接受别嘌醇组和非布索坦治疗的患者的平均每日用药剂量(Mg)分别为184.9±96.7和48.4mg15.8；接受别嘌醇治疗的患者有4.8%改用非布索他汀，而接受非布索他汀治疗的患者改用别嘌醇的比例为25.7%。非布索他汀组患者有较低的估计肾小球滤过率水平，更多的糖尿病或基础值(P<；0.0001)，别嘌醇组和非布索他汀组分别有29.2%和42.2%的患者达到目标SUA水平(P<；005)。非布索坦在达到SUA目标的患者中显著更有效(调整后的优势比为1.73；95%可信区间为1.48-2.01)。年龄较大的患者和女性达到SUA目标水平的可能性更大；然而，Charlson共病指数评分较高的患者、黑人或估计肾小球滤过率在15到15之间的患者
Background: Febuxostat is recommended as 1 of 2 first-line urate-lowering therapies (ULT) for treating gout in the 2012 American College of Rheumatology Guidelines. Several efficacy trials have compared febuxostat with allopurinol treatment, but real-world comparative data are limited. Methods: We compared effectiveness of the 2 agents in reaching serum urate (sUA) level goal (< 6 mg/dL) within 6 months (main endpoint), factors impacting the likelihood of reaching goal, and outcomes in allopurinol patients who were switched to febuxostat therapy after failing to reach sUA level goal. Data from the General Electric Electronic Medical Record database on adult patients with newly diagnosed gout, who had started treatment with allopurinol or febuxostat in 2009 or thereafter were analyzed. Descriptive statistics, bivariate analyses, and logistic regressions were used. Results: Allopurinol (n = 17 199) and febuxostat (n = 1190) patients had a mean +/- standard deviation (SD) age of 63.7 (+/- 13.37) years; most patients were men and white. Average daily medication doses (mg) in the first 6 months were 184.9 +/- 96.7 and 48.4 +/- 15.8 for allopurinol-and febuxostat-treated patients, respectively; 4.8% of allopurinol-treated patients switched to febuxostat, whereas 25.7% of febuxostat-treated patients switched to allopurinol. Febuxostat patients had lower estimated glomerular filtration rate levels, more diabetes mellitus, or tophi at baseline (P< 0.05) and 29.2% and 42.2% of patients in the allopurinol and febuxostat groups achieved goal sUA levels (P < 0.0001). Febuxostat was significantly more effective in patients reaching sUA goal (adjusted odds ratio, 1.73; 95% CI, 1.48-2.01). Older patients and women had greater likelihood of reaching sUA goal level; however, patients with higher Charlson Comorbidity Index scores, blacks, or those with estimated glomerular filtration rates between 15 to