Division of Rheumatology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Division of Rheumatology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Rheumatology (Oxford). 2024 Sep 1;63(9):2433-2441. doi: 10.1093/rheumatology/keae262.
To compare the risk of urolithiasis in gout patients initiating allopurinol, a xanthine oxidase inhibitor, vs benzbromarone, a uricosuric.
Using the 2011-20 Korea National Health Insurance Service database, we conducted a cohort study on gout patients initiating allopurinol vs benzbromarone as the first-line urate-lowering treatment. The primary outcome was a new onset urinary stone. The secondary outcome was a stone requiring intervention. We estimated hazard ratios (HRs) and 95% CIs using Cox proportional hazard models with a 5:1 ratio propensity-score matching on >80 variables. Subgroup analyses were done by age, sex, thiazide use and cardiovascular risk.
61 300 allopurinol initiators PS-matched on 12 260 benzbromarone initiators were included (mean age 59 years, 79% male). During a mean follow-up of 322 days, 619 urolithiasis cases occurred with an incidence rate of 0.87 per 100 person-years in allopurinol and 1.39 in benzbromarone initiators, showing a HR of 0.64 (95% CI, 0.51-0.80). Approximately 44% of urinary stones required intervention with a HR of 0.61 (95% CI, 0.43-0.88). The lower risk associated with allopurinol compared with benzbromarone persisted across subgroups but was greater in the high than non-high cardiovascular risk subgroup (P for interaction = 0.02).
This population-based cohort study found that allopurinol compared with benzbromarone was associated with a substantially lower risk of urolithiasis particularly in the presence of the high cardiovascular risk. This finding provides important safety information for clinicians' decision-making on urate-lowering treatments of different mechanisms of action.
比较起始应用黄嘌呤氧化酶抑制剂别嘌醇与尿酸排泄剂苯溴马隆的痛风患者发生尿路结石的风险。
利用 2011-20 年韩国国家健康保险服务数据库，我们对起始应用别嘌醇与苯溴马隆作为一线降尿酸治疗的痛风患者进行了队列研究。主要结局为新发尿路结石。次要结局为需要干预的结石。我们使用 Cox 比例风险模型，根据 >80 个变量进行了 5:1 比例倾向性评分匹配，估计了风险比（HR）和 95%置信区间（CI）。亚组分析根据年龄、性别、噻嗪类药物使用和心血管风险进行。
对 12260 名苯溴马隆起始患者进行了 61300 名别嘌醇起始患者的 5:1 比例倾向性评分匹配（平均年龄 59 岁，79%为男性）。在平均 322 天的随访期间，共有 619 例尿路结石发生，别嘌醇组和苯溴马隆组的发生率分别为 0.87/100 人年和 1.39/100 人年，HR 为 0.64（95%CI，0.51-0.80）。大约 44%的尿路结石需要干预，HR 为 0.61（95%CI，0.43-0.88）。与苯溴马隆相比，别嘌醇的风险降低在各亚组中持续存在，但在高心血管风险亚组中大于非高心血管风险亚组（P 交互=0.02）。
这项基于人群的队列研究发现，与苯溴马隆相比，别嘌醇与尿路结石的发生风险显著降低，特别是在存在高心血管风险的情况下。这一发现为临床医生在选择不同作用机制的降尿酸治疗方案时提供了重要的安全性信息。
