痛风患者开始使用别嘌醇时秋水仙碱预防相关不良事件的预后因素：回顾性队列研究。
Prognostic factors for colchicine prophylaxis-related adverse events when initiating allopurinol for gout: retrospective cohort study.
作者信息
Bajpai Ram, Partington Richard, Muller Sara, Forrester Harry, Mallen Christian D, Clarson Lorna, Padmanabhan Nishita, Whittle Rebecca, Roddy Edward
机构信息
School of Medicine, Keele University, Keele, UK.
Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
出版信息
Rheumatology (Oxford). 2025 Mar 1;64(3):1147-1154. doi: 10.1093/rheumatology/keae229.
OBJECTIVES
Colchicine is commonly used to prevent flares when starting urate-lowering therapy for gout. Patients with gout are frequently concurrently prescribed other medications (such as statins) that may interact with colchicine, increasing the risk of adverse events. The aim of this study was to describe potential prognostic factors for adverse events in patients prescribed colchicine when initiating allopurinol.
METHODS
We conducted a retrospective cohort study in linked UK Clinical Practice Research Datalink and Hospital Episode Statistics datasets. Adults initiating allopurinol for gout with colchicine (1 April 1997 to 30 November 2016) were included. Potential prognostic factors were defined, and the likelihood of adverse events, including diarrhoea, nausea or vomiting, myocardial infarction, neuropathy, myalgia, myopathy, rhabdomyolysis and bone marrow suppression, were estimated.
RESULTS
From 1 April 1997 to 30 November 2016, 13 945 people with gout initiated allopurinol with colchicine prophylaxis [mean age 63.9 (s.d. 14.7) years, 78.2% male]. One-quarter (26%, 95% CI 25%, 27%) were prescribed one or more potentially interacting medicines, most commonly statins (21%, 95% CI 20%, 22%). Statins were not associated with increased adverse events, although other drugs were associated with some adverse outcomes. Diarrhoea and myocardial infarction were associated with more comorbidities and more severe chronic kidney disease.
CONCLUSION
People were given colchicine prophylaxis despite commonly having preexisting prescriptions for medications with potential to interact with colchicine. Adverse events were more common in people who had more comorbidities and certain potentially interacting medications. Our findings will provide much-needed information about prognostic factors for colchicine-related adverse events that can inform treatment decisions about prophylaxis when initiating allopurinol.
目的
在开始痛风降尿酸治疗时，秋水仙碱常用于预防病情发作。痛风患者经常同时服用其他可能与秋水仙碱相互作用的药物（如他汀类药物），这会增加不良事件的风险。本研究的目的是描述在开始使用别嘌醇时服用秋水仙碱的患者发生不良事件的潜在预后因素。
方法
我们在英国临床实践研究数据链和医院事件统计数据集的关联数据中进行了一项回顾性队列研究。纳入了1997年4月1日至2016年11月30日期间开始使用别嘌醇并服用秋水仙碱治疗痛风的成年人。定义了潜在的预后因素，并估计了不良事件的发生可能性，包括腹泻、恶心或呕吐、心肌梗死、神经病变、肌痛、肌病、横纹肌溶解和骨髓抑制。
结果
1997年4月1日至2016年11月30日，13945例痛风患者开始使用别嘌醇并接受秋水仙碱预防治疗[平均年龄63.9（标准差14.7）岁，男性占78.2%]。四分之一（26%，95%CI 25%，27%）的患者同时服用了一种或多种可能相互作用的药物，最常见的是他汀类药物（21%，95%CI 20%，22%）。他汀类药物与不良事件增加无关，尽管其他药物与一些不良结局有关。腹泻和心肌梗死与更多的合并症和更严重的慢性肾病有关。
结论
尽管患者通常已有可能与秋水仙碱相互作用的药物处方，但仍给予秋水仙碱预防治疗。合并症较多和某些可能相互作用的药物使用者中不良事件更为常见。我们的研究结果将提供有关秋水仙碱相关不良事件预后因素的急需信息，可为开始使用别嘌醇时的预防治疗决策提供参考。
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