Dartmouth Medical School, Lebanon, NH 03756, USA.
Lancet. 2011 Jan 8;377(9760):165-77. doi: 10.1016/S0140-6736(10)60665-4. Epub 2010 Aug 16.
The approval of febuxostat, a non-purine-analogue inhibitor of xanthine oxidase, by the European Medicines Agency and the US Food and Drug Administration heralds a new era in the treatment of gout. The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Additionally, advances in our understanding of the transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals are translating into potential new treatments. In this Review, we focus on the clinical trials of febuxostat. We also review results from studies of pegloticase, a pegylated uricase in development, and we summarise data for several other pipeline drugs for gout, such as the selective uricosuric drug RDEA594 and various interleukin-1 inhibitors. Finally, we issue a word of caution about the proper use of the new drugs and the already available drugs for gout. At a time of important advances, we need to recommit ourselves to a rational approach to the treatment of gout.
欧洲药品管理局和美国食品药品监督管理局批准黄嘌呤氧化酶非嘌呤类似物抑制剂非布司他，标志着痛风治疗新时代的到来。使用改良尿酸酶快速降低治疗效果不佳的痛风患者血清尿酸浓度的方法正在不断发展。此外，人们对尿酸在肾近端小管中的转运和对单钠尿酸盐晶体的炎症反应的认识的进步，正在转化为潜在的新治疗方法。在这篇综述中，我们重点关注非布司他的临床试验。我们还回顾了聚乙二醇尿酸酶培格立酶的研究结果，并总结了几种其他用于痛风的在研药物的数据，如选择性促尿酸排泄药 RDEA594 和各种白细胞介素-1 抑制剂。最后，我们对新药物和已有痛风药物的正确使用提出了警告。在取得重要进展的同时，我们需要重新致力于痛风治疗的合理方法。
