Borghi C, Perez-Ruiz F
University of Bologna, Bologna, Italy.
Eur Rev Med Pharmacol Sci. 2016 Mar;20(5):983-92.
In patients with gout, serum uric acid (sUA) concentrations should be lowered at least below the target of 6 mg/dL (even below 5 mg/dL in patients with severe gout). To achieve this goal, urate lowering medications (ULMs) should be considered. Currently-used ULMs include xanthine-oxidase inhibitors such as allopurinol, febuxostat, as well as available uricosuric agents. However, evidence comparing these agents remains scant. We have conducted a systematic review and meta-analysis to retrieve evidence on the clinical trials on the above-mentioned drugs in the treatment of gout.
The following efficacy outcomes were considered in the meta-analysis: (1) % of patients meeting the therapeutic target for sUA level (<6 mg/dl) and (2) percentage reduction in sUA concentration at the end of the study compared with baseline values. An explorative analysis on safety was also conducted.
In total, 16 papers concerned febuxostat, 15 allopurinol, 4 benzbromarone and none involved probenecid. Overall, 70.7% of patients reached the target of sUA with febuxostat therapy; the reduction in sUA was 45.3%. Corresponding figures with allopurinol were 44.4% and 33.8%, respectively. The number of patients on benzbromarone (N=129) was too low to retrieve definitive findings. The advantage for febuxostat over allopurinol was evident also in patients with renal dysfunction. Safety analysis favored febuxostat over allopurinol (OR 0.85; 95% CI: 0.75-0.97).
On the basis of the reported data, febuxostat can play a major role in the treatment of hyperuricaemia and gout. Febuxostat is a suitable pharmacological option for first line treatment of gout, given its established efficacy and safety, documented in a high number of clinical studies and in daily practice.
对于痛风患者，血清尿酸（sUA）浓度应至少降至6mg/dL以下（重度痛风患者甚至应降至5mg/dL以下）。为实现这一目标，应考虑使用降尿酸药物（ULMs）。目前使用的ULMs包括黄嘌呤氧化酶抑制剂，如别嘌醇、非布司他，以及现有的促尿酸排泄药物。然而，比较这些药物的证据仍然很少。我们进行了一项系统评价和荟萃分析，以检索上述药物治疗痛风的临床试验证据。
荟萃分析中考虑了以下疗效结果：（1）达到sUA水平治疗目标（<6mg/dl）的患者百分比，以及（2）研究结束时与基线值相比sUA浓度降低的百分比。还进行了安全性的探索性分析。
总共16篇论文涉及非布司他，15篇涉及别嘌醇，4篇涉及苯溴马隆，没有涉及丙磺舒的。总体而言，非布司他治疗的患者中有70.7%达到了sUA目标；sUA降低了45.3%。别嘌醇的相应数字分别为44.4%和33.8%。服用苯溴马隆的患者数量（N=129）过少，无法得出明确结论。在肾功能不全患者中，非布司他优于别嘌醇的优势也很明显。安全性分析显示非布司他优于别嘌醇（OR 0.85；95%CI：0.75 - 0.97）。
根据报告的数据，非布司他在高尿酸血症和痛风的治疗中可发挥主要作用。鉴于其已证实的疗效和安全性，在大量临床研究和日常实践中都有记录，非布司他是痛风一线治疗的合适药物选择。
