Kim Aran, Kim Yunkyung, Kim Geun-Tae, Ahn Eunyoung, So Min Wook, Lee Seung-Geun
Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
Clin Rheumatol. 2020 Dec;39(12):3769-3776. doi: 10.1007/s10067-020-05161-w. Epub 2020 May 26.
INTRODUCTION/OBJECTIVES: Lifelong urate-lowering therapy (ULT) with xanthine oxidase inhibitors (XOIs), such as allopurinol and febuxostat, is the cornerstone of gout treatment. This study aimed to compare drug persistence between allopurinol and febuxostat as first-line ULT in patients with gout in real practice.
In this retrospective cohort study, we evaluated 602 patients with gout in whom allopurinol or febuxostat was newly initiated from December 2011 to November 2018 at a tertiary rheumatology centre. Persistence was defined as the duration from the first description date to the end of treatment with XOIs or the end of the study period (November 2019).
Among the 602 gout patients, the mean age was 60.2 years and 234 (38.9%) patients had tophi. Allopurinol and febuxostat were started in 237 (39.3%) and 365 (60.6%) patients, respectively. During the study period, 282 (46.8%) patients stopped taking XOIs, and the most common reason for XOI withdrawal was poor health literacy (61.3%). The 1- and 5-year persistence rates of XOIs were 67.2% and 40.9%, respectively. In the Kaplan-Meier analysis, persistence rates of allopurinol were significantly lower than those of febuxostat (p < 0.001). In the multivariable Cox regression model, allopurinol use was a significant risk factor for discontinuation of XOIs (HR = 2.01, p < 0.001). In addition, the presence of tophi and symptom duration < 24 months was independently associated with a higher risk of XOI withdrawal.
Long-term persistence of XOIs was suboptimal, and allopurinol had worse persistence rates than febuxostat among patients with gout. Key Points • Long-term persistence of xanthine oxidase inhibitors (XOIs) as first-line urate-lowering therapy (ULT) among patients with gout was suboptimal, and the major reason for XOI discontinuation was poor health literacy in our study. • We demonstrated that allopurinol had worse persistence rates than febuxostat among patients with gout, suggesting that febuxostat is a better option for long-term ULT in light of medication adherence in a real-world setting. • Patients with gout with tophi and shorter symptom duration were found to be at high risk for poor persistence of XOIs.
引言/目的：使用黄嘌呤氧化酶抑制剂（XOIs），如别嘌醇和非布司他进行终身降尿酸治疗（ULT）是痛风治疗的基石。本研究旨在比较别嘌醇和非布司他作为痛风患者一线ULT在实际应用中的药物持续性。
在这项回顾性队列研究中，我们评估了2011年12月至2018年11月在一家三级风湿病中心新开始使用别嘌醇或非布司他的602例痛风患者。持续性定义为从首次记录日期到使用XOIs治疗结束或研究期结束（2019年11月）的持续时间。
在602例痛风患者中，平均年龄为60.2岁，234例（38.9%）患者有痛风石。分别有237例（39.3%）和365例（60.6%）患者开始使用别嘌醇和非布司他。在研究期间，282例（46.8%）患者停止服用XOIs，停用XOIs最常见的原因是健康素养差（61.3%）。XOIs的1年和5年持续性率分别为67.2%和40.9%。在Kaplan-Meier分析中，别嘌醇的持续性率显著低于非布司他（p<0.001）。在多变量Cox回归模型中，使用别嘌醇是停用XOIs的一个显著危险因素（HR=2.01，p<0.001）。此外，痛风石的存在和症状持续时间<24个月与停用XOIs的较高风险独立相关。
XOIs的长期持续性不理想，在痛风患者中，别嘌醇的持续性率比非布司他更差。要点•在痛风患者中，黄嘌呤氧化酶抑制剂（XOIs）作为一线降尿酸治疗（ULT）的长期持续性不理想，在我们的研究中，停用XOIs的主要原因是健康素养差。•我们证明，在痛风患者中，别嘌醇的持续性率比非布司他更差，这表明从现实世界环境中的药物依从性来看，非布司他是长期ULT的更好选择。•发现有痛风石和症状持续时间较短的痛风患者存在XOIs持续性差的高风险。
