建议对痛风患者的抗痛风药物进行剂量个体化。
Dosage individualization proposed for anti-gout medications among the patients with gout.
机构信息
Nobel College Faculty of Health Sciences, Pokhara University, Kathmandu, Nepal.
Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal.
出版信息
PLoS One. 2021 Sep 17;16(9):e0257082. doi: 10.1371/journal.pone.0257082. eCollection 2021.
BACKGROUND
The conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to explore the need of individualization and optimization of the dose of anti-gout medications among gout patients.
METHODS
Cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and who were taking antigout medications. Patients not taking anti-gout medications and not showing willingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and verified with the BNF 80. Data were analyzed via R 4.0.3 by applying the multinomial logistic regression to analyze statistical significance of risk with various predictors, and considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and medicines were coded according to the WHO Guidelines for ATC classification and DDD assignment 2020.
RESULTS
The high risk of progression to CKD increased in the age range 54-63 and ≥84 years by 17.77 and 43.02 times, respectively. Also, high risk increased by 29.83 and 20.2 times for the overweight and the obese respectively. Aceclofenac 100mg was prescribed for maximum patients (30.5%). Need of dose individualization was realized in 30 patients, with maximum (7) in case of etoricoxib 90mg. Various glucocorticoids were prescribed for 36.9% patients, out of whom 3.8%required dose individualization and 15.9% patients with xanthine oxidase inhibitors, out of whom 1.3% required dose individualization.
CONCLUSION
Thirty cases required dose individualization, which was although minimal but could have meaningful impact on the clinical success of the individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups.
背景
传统的一刀切方法已经受到批评，特别是对于包括痛风在内的慢性疾病使用的几乎所有药物。本研究旨在探讨痛风患者中抗痛风药物剂量的个体化和优化的必要性。
方法
在尼泊尔勒利德布尔大都市市的两个痛风治疗中心，对 384 名新诊断的痛风患者进行了横断面研究，这些患者正在服用抗痛风药物。排除未服用抗痛风药物且不愿意参与的患者。使用 CKD 流行病学合作（CKD-EPI）肌酐方程（2009 年）计算 eGFR。根据《肾脏药物手册》和《英国国家处方集 80》确定要个体化的剂量。通过应用多变量逻辑回归分析各种预测因子的统计学意义，并考虑到 p 值<0.05 具有统计学意义，使用 R 4.0.3 对数据进行分析。合并症按照 ICD-11 编码，药物按照世界卫生组织（WHO）指南的 ATC 分类和 DDD 赋值 2020 进行编码。
结果
年龄在 54-63 岁和≥84 岁的患者，进展为 CKD 的风险分别增加了 17.77 倍和 43.02 倍。此外，超重和肥胖患者的风险分别增加了 29.83 倍和 20.2 倍。最大剂量（30.5%）处方了醋氯芬酸 100mg。有 30 名患者需要个体化剂量，其中依托考昔 90mg 最多（7 名）。各种糖皮质激素被处方给 36.9%的患者，其中 3.8%需要个体化剂量，3.8%的黄嘌呤氧化酶抑制剂患者需要个体化剂量，其中 15.9%需要个体化剂量。
结论
虽然需要个体化剂量的患者人数较少，但这可能对个体患者的临床成功产生有意义的影响。根据剂量个体化的建议，未来随访时可以优化这些患者的治疗。
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