Sharma Ena, Pedersen Brian, Terkeltaub Robert
Department of Medicine, San Diego Veterans Affairs Healthcare System, San Diego, CA, USA.
Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
Clin Med Insights Arthritis Musculoskelet Disord. 2019 Dec 9;12:1179544119890853. doi: 10.1177/1179544119890853. eCollection 2019.
The interleukin-1 (IL-1) receptor antagonist anakinra is an effective, off-label option in acute gout flares, when conventional therapy options are narrowed. We performed a retrospective, randomized, case-controlled study to gain clinical insight on baseline factors for gout patients most likely to receive anakinra, and ultimate mortality of those who received anakinra.
Of 1451 gout patients seen between January 2003 and January 2015 in a Veterans Affairs (VA) rheumatology group practice, under stringent managed care principles, 13 (100% male), who received anakinra at least once for flares, were compared with 1:4 age- and sex-matched gout controls. Each patient's first rheumatology encounter was studied by factor analysis for variables associated with later anakinra.
At baseline, patients that received anakinra had higher urate burden (palpable tophi [10/13] vs controls [16/52], = .003), serum urate ([10.6 mg/dL] vs controls [7.6 mg/dL], < .0001), and East Asian descent ([7/13] vs [16/52], = .041). The anakinra group had higher ultimate all-cause mortality ([6/13] vs controls [7/52], relative risk [RR] = 3.43, 95% confidence interval [CI] = 1.39-8.48, = .0076). Factor analysis showed baseline visit palpable tophus and statin use to be most strongly associated with later anakinra use. Increased mortality of anakinra users, as per a factorial analysis, was linked more strongly to comorbidities than to anakinra.
At baseline rheumatology gout encounter, higher urate, palpable tophi, statin prescription, and East Asian descent were associated with later anakinra use for flares. Mortality was more closely associated to the presence of comorbidities at baseline rheumatology visit than to anakinra prescription.
白细胞介素-1（IL-1）受体拮抗剂阿那白滞素在传统治疗方案受限的急性痛风发作中是一种有效的、非标签用药选择。我们进行了一项回顾性、随机、病例对照研究，以深入了解最有可能接受阿那白滞素治疗的痛风患者的基线因素，以及接受阿那白滞素治疗患者的最终死亡率。
在2003年1月至2015年1月期间，在退伍军人事务部（VA）风湿病小组诊所就诊的1451例痛风患者中，按照严格的管理式医疗原则，将至少接受过一次阿那白滞素治疗痛风发作的13例患者（均为男性）与年龄和性别匹配的1:4痛风对照患者进行比较。通过因子分析研究每位患者首次风湿病就诊时与后来使用阿那白滞素相关的变量。
在基线时，接受阿那白滞素治疗的患者有更高的尿酸盐负担（可触及的痛风石[10/13] vs对照[16/52]，P = 0.003）、血清尿酸（[10.6mg/dL] vs对照[7.6mg/dL]，P < 0.0001）以及东亚血统（[7/13] vs [16/52]，P = 0.041）。阿那白滞素组有更高的最终全因死亡率（[6/13] vs对照[7/52]，相对风险[RR] = 3.43，95%置信区间[CI] = 1.39 - 8.48，P = 0.0076）。因子分析显示基线就诊时可触及的痛风石和他汀类药物的使用与后来使用阿那白滞素的关联最为密切。根据析因分析，阿那白滞素使用者死亡率增加与合并症的关联比与阿那白滞素的关联更强。
在基线风湿病痛风就诊时，更高的尿酸、可触及的痛风石、他汀类药物处方以及东亚血统与后来使用阿那白滞素治疗痛风发作相关。死亡率与基线风湿病就诊时合并症的存在比与阿那白滞素处方的关联更为密切。
