Claus Liza W, Saseen Joseph J
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA,
Patient Relat Outcome Meas. 2018 Jul 18;9:231-238. doi: 10.2147/PROM.S108868. eCollection 2018.
Gouty arthritis is one of the most common rheumatic diseases, and the prevalence continues to rise, which is likely related to increased incidence of comorbidities, lifestyle factors, and suboptimal utilization of urate-lowering therapy. In recent years, multiple new guidelines have been published along with the approval of novel drug therapies. Still, gout remains a poorly controlled disease state that is accompanied by a reduced health-related quality of life, increased health care utilization, and overall negative socioeconomic effects, all of which have a negative impact on patient-related health outcomes. The key to success in gout management is utilization of urate-lowering therapy to prevent recurrence of acute gouty arthritis and to resolve tophi, if present. Xanthine oxidase inhibitors are first-line medications for the prevention of recurrent gout followed by uricosurics, including lesinurad (a uric acid reabsorption inhibitor) as an add-on option. The recent US Food and Drug Administration Safety Communication related to cardiovascular risk with febuxostat may result in increased use of allopurinol in combination therapy with a uricosuric agent such as lesinurad. In this review, we discuss gout management, clinical end points, and patient-related outcomes for consideration, summarize the evidence for combination therapy to achieve serum urate targets, and focus on lesinurad as a novel newer medication for the prevention of gout.
痛风性关节炎是最常见的风湿性疾病之一，其患病率持续上升，这可能与合并症发病率增加、生活方式因素以及降尿酸治疗的使用不充分有关。近年来，随着新型药物疗法的获批，多项新指南已发布。然而，痛风仍然是一种控制不佳的疾病状态，伴有健康相关生活质量下降、医疗保健利用率增加以及总体负面的社会经济影响，所有这些都对患者相关的健康结局产生负面影响。痛风管理成功的关键是使用降尿酸疗法来预防急性痛风性关节炎复发，并消除痛风石（如果存在）。黄嘌呤氧化酶抑制剂是预防复发性痛风的一线药物，其次是促尿酸排泄药，包括雷西纳德（一种尿酸重吸收抑制剂）作为附加选择。美国食品药品监督管理局最近发布的关于非布司他心血管风险的安全通讯可能会导致在与雷西纳德等促尿酸排泄药联合治疗中增加使用别嘌醇。在本综述中，我们讨论痛风管理、临床终点以及需要考虑的患者相关结局，总结联合治疗以实现血清尿酸目标的证据，并重点关注雷西纳德作为预防痛风的新型药物。
