Feher M D, Hepburn A L, Hogarth M B, Ball S G, Kaye S A
Lipid Clinic, London SW10 9NH, UK.
Rheumatology (Oxford). 2003 Feb;42(2):321-5. doi: 10.1093/rheumatology/keg103.
To assess the short-term urate-lowering effect of fenofibrate in men on long-term allopurinol therapy for hyperuricaemia and gout.
Ten male patients (38-74 yr) with a history of chronic tophaceous or recurrent acute gout with hyperuricaemia and on established allopurinol at 300-900 mg/day for > or =3 months were studied in an open-crossover study of fenofibrate therapy. Allopurinol at the established dose was continued throughout the study. Clinical and biochemical assessments (serum urate and creatinine, 24-h urinary excretion of urate and creatinine, liver function tests, creatine kinase and fasting serum lipids) were undertaken at: (i) baseline, (ii) after 3 weeks of once-daily therapy with micronized fenofibrate (Lipantil Micro) at 200 mg and (iii) 3 weeks after fenofibrate was withdrawn.
Fenofibrate was associated with a 19% reduction in serum urate after 3 weeks of treatment (mean+/-S.E. 0.37+/-0.04 vs 0.30+/-0.02 mM/l; P=0.004). The effect was reversed after a 3-week fenofibrate withdrawal period (0.30+/-0.02 vs 0.38+/-0.03 mM/l). There was a rise in uric acid clearance with fenofibrate treatment of 36% (7.2+/-0.9 vs 11.4+/-1.6 ml/min, normal range 6-11; P=0.006) without a significant change in creatinine clearance. Both total cholesterol and serum triglycerides were also reduced. No patient developed acute gout whilst taking fenofibrate.
Fenofibrate has a rapid and reversible urate-lowering effect in patients with hyperuricaemia and gout on established allopurinol prophylaxis. Fenofibrate may be a potential new treatment for hyperuricaemia and the prevention of gout, particularly in patients with coexisting hyperlipidaemia or those resistant to conventional therapy for hyperuricaemia.
评估非诺贝特对接受别嘌醇长期治疗的高尿酸血症和痛风男性患者的短期降尿酸效果。
在一项非诺贝特治疗的开放性交叉研究中，对10名男性患者（38 - 74岁）进行了研究，这些患者有慢性痛风石性或复发性急性痛风伴高尿酸血症病史，且已接受300 - 900毫克/天的别嘌醇治疗≥3个月。在整个研究过程中，继续使用既定剂量的别嘌醇。在以下时间点进行临床和生化评估（血清尿酸和肌酐、尿酸和肌酐的24小时尿排泄量、肝功能检查、肌酸激酶和空腹血脂）：（i）基线时；（ii）每日一次服用200毫克微粒化非诺贝特（力平之微粒型）治疗3周后；（iii）停用非诺贝特3周后。
治疗3周后，非诺贝特使血清尿酸降低了19%（平均值±标准误，0.37±0.04 vs 0.30±0.02毫摩尔/升；P = 0.004）。在停用非诺贝特3周后，这种效果逆转（0.30±0.02 vs 0.38±0.03毫摩尔/升）。非诺贝特治疗使尿酸清除率提高了36%（7.2±0.9 vs 11.4±1.6毫升/分钟，正常范围6 - 11；P = 0.006），而肌酐清除率无显著变化。总胆固醇和血清甘油三酯也均降低。在服用非诺贝特期间，无患者发生急性痛风。
对于接受既定别嘌醇预防治疗的高尿酸血症和痛风患者，非诺贝特具有快速且可逆的降尿酸作用。非诺贝特可能是高尿酸血症和痛风预防的一种潜在新疗法，尤其适用于合并高脂血症或对高尿酸血症传统治疗耐药的患者。
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