Comparative efficacy of low-dose versus regular-dose colchicine to prevent flares in gout patients initiated on urate-lowering therapies
Comparative efficacy of low-dose versus regular-dose colchicine to prevent flares in gout patients initiated on urate-lowering therapies
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DOI：
10.1093/rheumatology/keab303
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发表时间：
2022-01-01
期刊：
影响因子：
5.5
通讯作者：
Kim, Yong-Gil
中科院分区：
文献类型：
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作者：
Ahn, Soo Min;Oh, Ji Seon;Kim, Yong-Gil
目的 本研究的目的是比较在开始降尿酸治疗时，常规剂量（RD，1.2毫克/天）与低剂量（LD，0.6毫克/天）秋水仙碱对痛风发作的预防效果。
方法 在这项回顾性队列研究中，我们纳入了开始使用别嘌醇或非布司他并联合秋水仙碱治疗的痛风患者，并对他们进行了3个月的随访。我们根据秋水仙碱的剂量分析了痛风发作率和不良事件发生率。我们进行了治疗权重的逆概率（IPTW）和加权逻辑回归分析以评估治疗效果。对痛风发作和不良事件的分析是在意向性治疗（ITT）和符合方案集（PP）的基础上进行的。
结果 在总共419例痛风患者中，177例患者（42.2%）接受了低剂量秋水仙碱治疗，而242例患者（57.8%）接受了常规剂量秋水仙碱治疗。与常规剂量组相比，低剂量组的体重指数（BMI）和估算肾小球滤过率较低，心血管疾病发生率较高。在经IPTW调整的分析中，低剂量组和常规剂量组之间痛风发作事件无显著差异[意向性治疗：14.3%对11.3%；比值比（OR）：1.309，95%置信区间：0.668，2.566，P = 0.432；符合方案集：15.3%对10.0%；OR：1.623，95%置信区间：0.765，3.443，P = 0.207]。然而，低剂量秋水仙碱与常规剂量秋水仙碱相比，不良事件发生率较低[意向性治疗：8.2%对17.9%；OR：0.410，95%置信区间：0.217，0.777；P < 0.05；符合方案集：8.4%对17.2%；OR：0.442，95%置信区间：0.223，0.878；P < 0.05]。
结论 我们的数据表明，与常规剂量秋水仙碱相比，低剂量秋水仙碱能够充分预防痛风发作，且不良事件更少。
Objective The objective of this study was to compare the prophylactic effect of regular-dose (RD, 1.2 mg/day) vs low-dose (LD, 0.6 mg/day) colchicine on gout flare when initiating urate-lowering therapy. Methods In this retrospective cohort study, we included gout patients who were initiated on either allopurinol or febuxostat, in combination with colchicine therapy and followed them up for 3 months. We analysed the rates of gout flare and adverse events according to the dose of colchicine. We performed the inverse probability of treatment weighting (IPTW) and weighted logistic regression analysis to assess the treatment effect. Analysis of gout flares and adverse events was performed on an intention-to-treat (ITT) and per-protocol (PP) basis. Results Of the total of 419 patients with gout, 177 patients (42.2%) received LD colchicine, whereas 242 patients (57.8%) received RD colchicine. Lower BMI and estimated glomerular filtration rate, and higher incidence of cardiovascular disease were seen in the LD group than in the RD group. In IPTW-adjusted analysis, events of gout flare were not significantly different between the LD and RD groups [ITT: 14.3% vs 11.3%; odds ratio (OR): 1.309, 95% CI: 0.668, 2.566, P = 0.432; PP: 15.3% vs 10.0%; OR: 1.623, 95% CI: 0.765, 3.443, P = 0.207]. However, LD colchicine was associated with a lower rate of adverse events than RD colchicine [ITT: 8.2% vs 17.9%; OR: 0.410, 95% CI: 0.217, 0.777; P < 0.05; PP: 8.4% vs 17.2%; OR: 0.442, 95% CI: 0.223, 0.878; P < 0.05]. Conclusion Our data suggest that LD colchicine can adequately prevent gout flare with fewer adverse events compared with RD colchicine.