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不同剂量常用降尿酸药物对痛风患者的疗效：一项随机对照试验的网状Meta分析

Efficacy of different dosages of common uric acid-lowering medications in gout patients: a network meta-analysis of randomized control trials.

作者信息

Zheng Xiaojia, Xie Cunxiang, Fang Jinying, Huang Zhenghui, Huang Jian, Zhao Luming, Ye Guancheng, Wang Hailong

机构信息

Department of Rheumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.

出版信息

Front Pharmacol. 2025 Jun 25;16:1565530. doi: 10.3389/fphar.2025.1565530. eCollection 2025.

DOI:10.3389/fphar.2025.1565530
PMID:40635751
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12237641/
Abstract

PURPOSE

Urate lowering therapy (ULT) is extensively utilized for managing patients with gout. This study aims to compare the efficacy of different ULTs on serum uric acid (SUC) levels, gout flares, and adverse events (AEs) in gout patients.

METHODS

Studies comparing the efficacy of febuxostat, allopurinol, benzbromarone, and topixostat with placebo were searched up to March 2024. Stata 15.1 and R software 4.2.3 were employed to rank the efficacy of each ULT.

RESULTS

This study included 30 studies, involving 20,040 patients. All ULTs resulted in notably lower SUC levels compared to placebo/no ULT. Febuxostat 120 mg markedly reduced SUC levels compared to allopurinol and benzbromarone 25 mg (mean difference = 2.16, 95% confidence interval [0.27, 4.06], P < 0.05). Allopurinol 200/300 mg was the best choice to reduce gout flares. In terms of AEs, the allopurinol group (300 mg) had the lowest incidence of cardiovascular and renal abnormalities. Moreover, the incidence of AEs was observed to rise with increasing doses. Future well-designed randomized control trials are required to further confirm these findings.

CONCLUSION

The study results indicate that febuxostat is the most effective ULT drug to treat gout. It can effectively help gout patients reduce SUC levels. Researchers should pay attention to the safety of drug doses.

摘要

目的

降尿酸治疗（ULT）被广泛用于痛风患者的管理。本研究旨在比较不同ULT对痛风患者血清尿酸（SUC）水平、痛风发作及不良事件（AE）的疗效。

方法

检索截至2024年3月比较非布司他、别嘌醇、苯溴马隆和托匹司他与安慰剂疗效的研究。使用Stata 15.1和R软件4.2.3对每种ULT的疗效进行排名。

结果

本研究纳入30项研究，涉及20,040例患者。与安慰剂/未进行ULT相比，所有ULT均使SUC水平显著降低。与25 mg别嘌醇和苯溴马隆相比，120 mg非布司他显著降低了SUC水平（平均差值 = 2.16，95%置信区间[0.27, 4.06]，P < 0.05）。200/300 mg别嘌醇是减少痛风发作的最佳选择。在AE方面，别嘌醇组（300 mg）心血管和肾脏异常的发生率最低。此外，观察到AE的发生率随剂量增加而上升。未来需要设计良好的随机对照试验来进一步证实这些发现。

结论

研究结果表明，非布司他是治疗痛风最有效的ULT药物。它能有效帮助痛风患者降低SUC水平。研究人员应关注药物剂量的安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/7308e4173dc5/fphar-16-1565530-g012.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/56454a76aa4a/fphar-16-1565530-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/bcea35b70ffd/fphar-16-1565530-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/0317510fc06d/fphar-16-1565530-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/679cb1770852/fphar-16-1565530-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/23bf9cb75148/fphar-16-1565530-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/53b665457b69/fphar-16-1565530-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/85a2c4083e32/fphar-16-1565530-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/94b5c962abd2/fphar-16-1565530-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/ed1795a99f38/fphar-16-1565530-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/7308e4173dc5/fphar-16-1565530-g012.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/56454a76aa4a/fphar-16-1565530-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/bcea35b70ffd/fphar-16-1565530-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/0d525fa17fc1/fphar-16-1565530-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/d43e16084ca6/fphar-16-1565530-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/0317510fc06d/fphar-16-1565530-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/679cb1770852/fphar-16-1565530-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/23bf9cb75148/fphar-16-1565530-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/53b665457b69/fphar-16-1565530-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/85a2c4083e32/fphar-16-1565530-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/94b5c962abd2/fphar-16-1565530-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/ed1795a99f38/fphar-16-1565530-g011.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3cab/12237641/7308e4173dc5/fphar-16-1565530-g012.jpg

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本文引用的文献

1
Comparison of the efficacy and safety of benzbromarone and febuxostat in gout and hyperuricemia: a systematic review and meta-analysis.苯溴马隆和非布司他治疗痛风和高尿酸血症的疗效与安全性比较：一项系统评价和荟萃分析
Clin Rheumatol. 2024 May;43(5):1745-1754. doi: 10.1007/s10067-024-06933-4. Epub 2024 Mar 16.
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Cardiovascular safety of febuxostat versus allopurinol among the Asian patients with or without gout: A systematic review and meta-analysis.非布司他与别嘌醇在有或无痛风的亚洲患者中的心血管安全性：系统评价和荟萃分析。
Clin Transl Sci. 2024 Mar;17(3):e13757. doi: 10.1111/cts.13757.
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Superiority of Low-Dose Benzbromarone Add-On to Low-Dose Febuxostat Compared With Febuxostat Monotherapy in Gout With Combined-Type Hyperuricemia.
低剂量苯溴马隆联合低剂量非布司他对比非布司他单药治疗混合型高尿酸血症痛风的疗效优势
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Effectiveness and safety of different doses of febuxostat compared with allopurinol in the treatment of hyperuricemia: a meta-analysis of randomized controlled trials.不同剂量非布司他与别嘌醇治疗高尿酸血症的疗效和安全性：一项随机对照试验的荟萃分析。
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Emerging Urate-Lowering Drugs and Pharmacologic Treatment Strategies for Gout: A Narrative Review.新兴的降尿酸药物和痛风的药物治疗策略：一篇叙述性综述。
Drugs. 2023 Nov;83(16):1501-1521. doi: 10.1007/s40265-023-01944-y. Epub 2023 Oct 11.
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Gout therapeutics and drug delivery.痛风治疗药物和药物输送。
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