使用 "开始-低剂量-继续-低剂量 "的剂量递增策略预测别嘌醇新用药者的痛风复发。

IF 3.7 2区 医学 Q1 RHEUMATOLOGY Arthritis Care & Research Pub Date : 2024-05-20 DOI:10.1002/acr.25376
Lisa K. Stamp, Anne Horne, Borislav Mihov, Jill Drake, Janine Haslett, Peter Chapman, Christopher Frampton, Nicola Dalbeth
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引用次数: 0

摘要

目的采用 "起点低、进展慢 "的剂量递增策略,确定开始服用别嘌醇时痛风复发的预测因素:我们对一项为期 12 个月的双盲安慰剂对照非劣效性试验进行了事后分析,试验参与者在最初 6 个月中被按 1:1 随机分配到每日服用 0.5 毫克秋水仙碱或安慰剂。试验采用多变量逻辑回归模型来确定试验前六个月和后六个月痛风发作的独立预测因素:多变量分析表明,头六个月痛风复发的风险与开始服用别嘌醇前一个月痛风复发(几率比(OR)(95% 置信区间(CI))2.65(1.36-5.17))和别嘌醇 100 毫克起始剂量(OR(95% 置信区间(CI))3.21(1.41-7.27))之间存在显著关联。停用秋水仙碱或安慰剂后,在试验的最后6个月中痛风复发的预测因素包括:曾服用秋水仙碱(OR (95% CI) 2.95 (1.48-5.86))、停药前一个月至少复发一次(OR (95% CI) 5.39 (2.21-13.15))、第6个月时血清尿酸盐≥0.36mmol/L(OR (95% CI) 2.85 (1.14-7.12)):在开始使用别嘌呤醇时,采用 "起始低、进展慢 "的剂量递增策略进行抗炎预防,可能最适合那些在开始使用别嘌呤醇前一个月内痛风复发且开始每天使用100毫克别嘌呤醇的患者。对于那些在开始服用别嘌醇的前 6 个月中痛风持续发作且尚未达到血清尿酸目标值的患者,可能需要更长的预防期。
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Predicting Gout Flares in People Starting Allopurinol Using the Start-Low Go-Slow Dose Escalation Strategy

Objective

The study objective was to determine predictors of gout flare when commencing allopurinol using the “start-low go-slow” dose escalation strategy.

Methods

A post hoc analysis of a 12-month double-blind placebo-controlled noninferiority trial with participants randomized 1:1 to colchicine 0.5 mg daily or placebo for the first six months was undertaken. Multivariate logistic regression models were used to identify independent predictors of gout flares in the first and last six months of the trial.

Results

Multivariable analysis revealed a significant association between risk of a gout flare in the first six months and flare in the month before starting allopurinol (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.36–5.17) and allopurinol 100 mg starting dose (OR 3.21, 95% CI 1.41–7.27). The predictors of any gout flares in the last six months of the trial, after stopping colchicine or placebo, were having received colchicine (OR 2.95, 95% CI 1.48–5.86), at least one flare in the month before stopping study drug (OR 5.39, 95% CI 2.21–13.15), and serum urate ≥0.36 mmol/L at month 6 (OR 2.85, 95% CI 1.14–7.12).

Conclusion

Anti-inflammatory prophylaxis when starting allopurinol using the “start-low go-slow” dose escalation strategy may be best targeted at those who have had a gout flare in the month before starting allopurinol and are commencing allopurinol 100 mg daily. For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required.

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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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