Shen Xiaoju, Li Jingjie, Fu Qian, Liu Longshan, Gao Xiang, Chen Xiao, Chen Pan, Wang Changxi
Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.
J Clin Pharm Ther. 2019 Apr;44(2):318-326. doi: 10.1111/jcpt.12794. Epub 2018 Dec 23.
Febuxostat and allopurinol are xanthine oxidase inhibitors for urate-lowering therapy. The efficacy and safety of febuxostat and allopurinol have been mostly reported in hyperuricemia patients with normal renal function. Here, we aimed to compare the effects of these two drugs in early post-renal transplant recipients, focusing on evaluating the urate-lowering effect and recovery of allograft renal function.
A retrospective cohort study was performed in early post-renal transplant recipients with new onset of hyperuricemia receiving febuxostat or allopurinol therapy. Serum uric acid (UA) and estimated glomerular filtration rate (eGFR) were detected on days 3, 7 and 15 and months 1, 3 and 6 after therapy initiation. Liver and blood functions were monitored and other adverse events were recorded.
A total of 48 and 33 patients were enrolled in the febuxostat and allopurinol groups, respectively. Significant UA-lowering effects were observed on day 3 in both groups. Febuxostat caused a more rapid UA decline, starting on day 3 and lasting for 1 month. The most apparent contrast was found in UA level (267.25 ± 93.66 vs 334.18 ± 96.56 μmol/L, P = 0.003) on day 7; 62.5% and 30.3% of patients achieved target UA level in febuxostat and allopurinol groups respectively on day 3 (P = 0.004), but there was no significant difference between two groups from days 15 to months 6. The median times to achieve target UA level were 3 and 5 days in febuxostat and allopurinol groups respectively (P = 0.002). The eGFR levels and recovering rates were gradually upregulated but no significant differences were found between two groups. No abnormities related to febuxostat or allopurinol were observed.
This is the first comprehensive evaluation of UA-lowering effects of febuxostat and allopurinol in early post-renal transplant recipients. Febuxostat caused a marginally quicker serum UA-lowering effect than allopurinol, but there was no advantage for long-term use of febuxostat. The drugs had no significant differences in impacting renal allograft function recovery, and both were well tolerated.
非布司他和别嘌醇是用于降尿酸治疗的黄嘌呤氧化酶抑制剂。非布司他和别嘌醇的疗效及安全性大多在肾功能正常的高尿酸血症患者中报道。在此，我们旨在比较这两种药物在肾移植术后早期受者中的效果，重点评估降尿酸作用及移植肾功能的恢复情况。
对肾移植术后早期新发高尿酸血症并接受非布司他或别嘌醇治疗的受者进行一项回顾性队列研究。在治疗开始后的第3、7和15天以及第1、3和6个月检测血清尿酸（UA）和估计肾小球滤过率（eGFR）。监测肝功能和血液功能，并记录其他不良事件。
非布司他组和别嘌醇组分别纳入48例和33例患者。两组在第3天均观察到显著的降尿酸效果。非布司他使UA下降更快，从第3天开始并持续1个月。最明显的差异出现在第7天的UA水平（267.25±93.66 vs 334.18±96.56μmol/L，P = 0.003）；非布司他组和别嘌醇组分别有62.5%和30.3%的患者在第3天达到目标UA水平（P = 0.004），但在第15天至第6个月两组之间无显著差异。非布司他组和别嘌醇组达到目标UA水平的中位时间分别为3天和5天（P = 0.002）。eGFR水平及恢复率逐渐上调，但两组之间无显著差异。未观察到与非布司他或别嘌醇相关的异常情况。
这是首次对非布司他和别嘌醇在肾移植术后早期受者中的降尿酸效果进行全面评估。非布司他使血清UA下降的效果略快于别嘌醇，但长期使用非布司他并无优势。两种药物在影响移植肾功能恢复方面无显著差异，且耐受性均良好。
