Oh Yoon-Jeong, Moon Ki Won
Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Korea.
J Clin Med. 2020 May 15;9(5):1488. doi: 10.3390/jcm9051488.
Colchicine has been effectively used to prevent acute flares in patients with gout, but drug-related adverse events have frequently occurred. We investigated whether colchicine therapy with febuxostat is associated with hepatotoxicity in gout patients. Gout patients treated with ( = 121) or without ( = 57) colchicine were enrolled upon initiating febuxostat as a urate-lowering treatment, and clinical and laboratory data at diagnosis were compared. Logistic regression analysis was performed to evaluate the risk factors related to hepatotoxicity. Median age of the with-colchicine and without-colchicine groups was 51.0 (37.0-62.0) and 56.0 (43.5-68.5) years, respectively. During the three months of febuxostat prescription, the prevalence of hepatotoxicity was 13/121 (10.9%) in the with-colchicine group and 4/57 (7.0%) in the without-colchicine group, without statistical significance. The rate of colchicine use was not different between the study subjects with or without hepatotoxicity (76.5% vs. 67.1%, = 0.587). Pre-existing liver disease was significantly associated with increased risk of hepatotoxicity after febuxostat treatment (odds ratio, 4.083; 95% confidence interval, 1.326-12.577; = 0.014). Colchicine may be safely used as a prophylactic agent for gout patients with febuxostat. However, upon initiating febuxostat, it is recommended to monitor the development of acute liver injury in gout patients with underlying liver disease.
秋水仙碱已被有效地用于预防痛风患者的急性发作，但与药物相关的不良事件经常发生。我们研究了秋水仙碱与非布司他联合治疗是否会使痛风患者出现肝毒性。在开始使用非布司他进行降尿酸治疗时，纳入了接受（n = 121）或未接受（n = 57）秋水仙碱治疗的痛风患者，并比较了诊断时的临床和实验室数据。进行逻辑回归分析以评估与肝毒性相关的危险因素。接受秋水仙碱治疗组和未接受秋水仙碱治疗组的中位年龄分别为51.0（37.0 - 62.0）岁和56.0（43.5 - 68.5）岁。在非布司他处方的三个月期间，接受秋水仙碱治疗组的肝毒性患病率为13/121（10.9%），未接受秋水仙碱治疗组为4/57（7.0%），无统计学意义。有或无肝毒性的研究对象之间秋水仙碱的使用率无差异（76.5%对67.1%，P = 0.587）。既往有肝病与非布司他治疗后肝毒性风险增加显著相关（比值比，4.083；95%置信区间，1.326 - 12.577；P = 0.014）。秋水仙碱可安全地用作非布司他治疗的痛风患者的预防药物。然而，在开始使用非布司他时，建议监测有潜在肝病的痛风患者急性肝损伤的发生情况。
