Department of Rheumatology, Middlemore Hospital, South Auckland, Auckland, New Zealand.
J Rheumatol. 2013 Jun;40(6):872-6. doi: 10.3899/jrheum.121301. Epub 2013 Mar 1.
Probenecid is recommended as urate-lowering therapy (ULT) in patients with gout where xanthine oxidase inhibitors are ineffective, not tolerated, or contraindicated. The aim of our study was to determine the efficacy of probenecid to achieve serum urate (SU) targets (< 0.36 mmol/l) in clinical practice.
We identified 57 patients prescribed with probenecid from a database of 521 rheumatology clinic attenders with gout. Demographic characteristics, indications for probenecid, probenecid doses, side effects, and laboratory data including estimated glomerular filtration rate (eGFR) and SU were recorded.
There were 30/57 (53%) patients treated with probenecid as monotherapy and 27/57 (47%) patients treated with probenecid in combination with allopurinol. Target SU concentrations (< 0.36 mmol/l) were achieved in 10/30 (33%) of the probenecid monotherapy group and 10/27 (37%) of the combination treatment group. Baseline SU concentrations, but not eGFR or probenecid dose, independently predicted achievement of target SU. Target SU was achieved in 5/15 (33%) patients with eGFR < 50 ml/min/1.73 m(2). There was no difference in the percentage of patients achieving SU target in those with eGFR < 50 ml/min/1.73 m(2) compared with those with eGFR ≥ 50 ml/min/1.73 m(2). Adverse events attributed to probenecid were observed in 8/42 (19%) patients with eGFR ≥ 50 ml/min/1.73 m(2) and in 2/15 (13%) patients with eGFR < 50 ml/min/1.73 m(2).
Probenecid has moderate efficacy as ULT in clinical management of patients with complex gout who have a lack of efficacy or intolerance to allopurinol. Patients with chronic kidney disease may respond to probenecid with similar rates of adverse events.
别嘌呤醇无效、不耐受或禁忌时，推荐使用丙磺舒作为降尿酸治疗 (ULT) 药物，以治疗痛风患者。本研究旨在确定丙磺舒在临床实践中实现血清尿酸 (SU) 目标（< 0.36mmol/l）的疗效。
我们从 521 例痛风就诊者的数据库中确定了 57 例接受丙磺舒治疗的患者。记录了人口统计学特征、丙磺舒的适应证、丙磺舒剂量、副作用以及包括估算肾小球滤过率 (eGFR) 和 SU 在内的实验室数据。
有 30/57（53%）例患者接受丙磺舒单药治疗，27/57（47%）例患者接受丙磺舒联合别嘌呤醇治疗。在丙磺舒单药治疗组的 10/30（33%）例和联合治疗组的 10/27（37%）例患者中，达到了目标 SU 浓度（< 0.36mmol/l）。基线 SU 浓度，而不是 eGFR 或丙磺舒剂量，独立预测了目标 SU 的实现。在 eGFR<50ml/min/1.73m2 的 5/15（33%）例患者中达到了 SU 目标。在 eGFR<50ml/min/1.73m2 的患者中与 eGFR≥50ml/min/1.73m2 的患者相比，达到 SU 目标的患者百分比没有差异。在 eGFR≥50ml/min/1.73m2 的 42 例患者中观察到 8/42（19%）例和在 eGFR<50ml/min/1.73m2 的 15 例患者中观察到 2/15（13%）例患者出现丙磺舒相关不良事件。
在对别嘌呤醇疗效不佳或不耐受的复杂痛风患者的临床管理中，丙磺舒作为 ULT 具有中等疗效。慢性肾脏病患者可能对丙磺舒有类似的不良反应发生率的反应。
