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2.
BMJ Open ; 14(8): e084665, 2024 Aug 03.
Article de Anglais | MEDLINE | ID: mdl-39097306

RÉSUMÉ

INTRODUCTION: Gout is one of the most common forms of arthritis worldwide. Gout is particularly prevalent in Aotearoa/New Zealand and is estimated to affect 13.1% of Maori men, 22.9% of Pacific men and 7.4% of New Zealand European men. Effective long-term treatment requires lowering serum urate to <0.36 mmol/L. Allopurinol is the most commonly used urate-lowering medication worldwide. Despite its efficacy and safety, the allopurinol dose escalation treat-to-target serum urate strategy is difficult to implement and there are important inequities in allopurinol prescribing in Aotearoa. The escalation strategy is labour intensive, time consuming and costly for people with gout and the healthcare system. An easy and effective way to dose-escalate allopurinol is required, especially as gout disproportionately affects working-age Maori men and Pacific men, who frequently do not receive optimal care. METHODS AND ANALYSIS: A 12-month non-inferiority randomised controlled trial in people with gout who have a serum urate ≥ 0.36 mmol/l will be undertaken. 380 participants recruited from primary and secondary care will be randomised to one of the two allopurinol dosing strategies: intensive nurse-led treat-to-target serum urate dosing (intensive treat-to-target) or protocol-driven dose escalation based on dose predicted by an allopurinol dosing model (Easy-Allo). The primary endpoint will be the proportion of participants who achieve target serum urate (<0.36 mmol/L) at 12 months. ETHICS AND DISSEMINATION: The New Zealand Northern B Health and Disability Ethics Committee approved the study (2022 FULL 13478). Results will be disseminated in peer-reviewed journals and to participants. TRIAL REGISTRATION NUMBER: ACTRN12622001279718p.


Sujet(s)
Allopurinol , Antigoutteux , Goutte , Acide urique , Humains , Allopurinol/administration et posologie , Allopurinol/usage thérapeutique , Goutte/traitement médicamenteux , Goutte/sang , Nouvelle-Zélande , Antigoutteux/administration et posologie , Antigoutteux/usage thérapeutique , Acide urique/sang , Mâle , Relation dose-effet des médicaments , Adulte , Essais d'équivalence comme sujet , Femelle
4.
S D Med ; 77(2): 81-86, 2024 Feb.
Article de Anglais | MEDLINE | ID: mdl-38986162

RÉSUMÉ

Gout is inflammatory arthritis caused by monosodium urate crystal deposition in articular and non-articular structures. Acute gout flares are often monoarticular/polyarticular involving lower extremity joints characteristically involving 1st metatarsophalangeal joint. However, gout flares can also be polyarticular, involving upper extremity joints, especially in patients with multiple comorbidities and contraindications to urate-lowering therapies (ULT). Risk factors exacerbating gout flares include obesity, high alcohol and purine-rich food consumption, and the use of diuretics. Diagnosis requires synovial fluid analysis with direct visualization of monosodium urate crystals. Acute flares are managed with steroids, non-steroidal anti-inflammatory drugs, or colchicine. Long-term management includes lifestyle modifications including a heavy emphasis on weight loss, avoidance of alcohol, purine-rich foods, and diuretics. ULT is indicated in patients with 2 or more gout flares/year, tophi, or radiographic evidence of gouty arthropathy. Although allopurinol is the first-line ULT agent, it does carry a risk of inducing severe cutaneous adverse reactions, especially in patients with chronic kidney disease and patients harboring the HLA-B*5801 allele. Other ULT agents include febuxostat and probenecid. ULT is usually titrated to achieve goal serum uric acid (SUA) levels below 6 mg/dL. However, in patients with tophi, a lower SUA target of less than 5 mg/dL should be implemented for prompt urate crystal dissolution.


Sujet(s)
Antigoutteux , Goutte , Humains , Goutte/diagnostic , Goutte/thérapie , Goutte/traitement médicamenteux , Antigoutteux/usage thérapeutique , Facteurs de risque , Acide urique/sang , Colchicine/usage thérapeutique , Anti-inflammatoires non stéroïdiens/usage thérapeutique
5.
Nutrients ; 16(14)2024 Jul 19.
Article de Anglais | MEDLINE | ID: mdl-39064767

RÉSUMÉ

Although patients with hyperuricemia and gout often have dyslipidemia, the effects of febuxostat, a xanthine oxidase inhibitor, on their lipid profiles are unclear. Thus, we performed a sub-analysis of the randomized PRIZE study in which the effects of febuxostat on carotid atherosclerosis were investigated in patients with hyperuricemia. The participants were randomized to the febuxostat or control group. The primary endpoint of this sub-analysis was changes in the patients' non-high-density lipoprotein cholesterol (HDL-C) levels from baseline to 6-month follow-up. Correlations between the changes in lipid profiles and cardiometabolic parameters were also evaluated. In total, 456 patients were included. From baseline to 6 months, non-HDL-C levels were significantly reduced in the febuxostat group (-5.9 mg/dL, 95% confidence interval [CI]: -9.1 to -2.8 mg/dL, p < 0.001), but not in the control group (-1.3 mg/dL, 95% CI: -4.4 to 1.8, p = 0.348). The reduction in non-HDL-C levels was more pronounced in women and correlated with changes in serum uric acid and estimated glomerular filtration rate levels only in the febuxostat group. In patients with hyperuricemia, febuxostat treatment was associated with reduced non-HDL-C levels from baseline to the 6-month follow-up compared to the control treatment, suggesting that the lipid-lowering effect of febuxostat should be considered when targeting dyslipidemia.


Sujet(s)
Fébuxostat , Hyperuricémie , Lipides , Xanthine oxidase , Humains , Fébuxostat/usage thérapeutique , Fébuxostat/pharmacologie , Hyperuricémie/traitement médicamenteux , Hyperuricémie/sang , Xanthine oxidase/antagonistes et inhibiteurs , Mâle , Femelle , Adulte d'âge moyen , Lipides/sang , Sujet âgé , Acide urique/sang , Antigoutteux/usage thérapeutique , Antigoutteux/pharmacologie , Cholestérol HDL/sang , Artériopathies carotidiennes/traitement médicamenteux , Artériopathies carotidiennes/sang , Dyslipidémies/traitement médicamenteux , Dyslipidémies/sang , Débit de filtration glomérulaire/effets des médicaments et des substances chimiques
6.
Isr Med Assoc J ; 26(7): 459, 2024 Aug.
Article de Anglais | MEDLINE | ID: mdl-39082458
8.
BMC Surg ; 24(1): 186, 2024 Jun 14.
Article de Anglais | MEDLINE | ID: mdl-38877436

RÉSUMÉ

BACKGROUND/PURPOSE: Patients with gout are at risk for increased serum uric acid (SUA) levels and gout attacks in the short term after undergoing bariatric surgery, and the purpose of this study was to evaluate the benefits of short-term treatment with uric acid-lowering medication after bariatric surgery for the control of gout attacks and SUA levels in patients with gout. METHODS: 71 patients who underwent SG from January 2020 to December 2022 were prospectively included. These patients were diagnosed with hyperuricemia before surgery and had a history of gout attacks. Patients were classified into a drug-treatment group (DTG, n = 32) and a non-drug-treatment group (NDTG, n = 39) according to whether they took uric acid-lowering medication after surgery. Changes in the number of gout attacks, body mass index (BMI), and SUA levels at 1 week, 1 month, 3 months, and 6 months after bariatric surgery were measured in both groups. RESULTS: In the DTG, 22 patients (68.8%) experienced an increase in SUA within 1 week, 3 patients (9.4%) had an acute attack of gout within the first month, and no patients had a gout attack thereafter. In the NDTG, 35 patients (89.7%) experienced an increase in SUA within 1 week, 7 patients (17.9%) had an acute gout attack within the first month, and 4 patients (10.3%) experienced gout attacks between month 1 and month 3 postoperatively. Both groups were free of gout attacks between the 3rd and 6th postoperative month and showed a significant decrease in SUA and BMI by the sixth month. CONCLUSION: In patients with gout, continued use of uric acid-lowering medication after bariatric surgery is beneficial in reducing the number of gout attacks and the risk of rising SUA.


Sujet(s)
Chirurgie bariatrique , Antigoutteux , Goutte , Acide urique , Humains , Goutte/sang , Chirurgie bariatrique/méthodes , Mâle , Femelle , Adulte d'âge moyen , Acide urique/sang , Antigoutteux/usage thérapeutique , Adulte , Études prospectives , Hyperuricémie/sang , Hyperuricémie/étiologie , Indice de masse corporelle , Complications postopératoires/prévention et contrôle , Complications postopératoires/sang , Complications postopératoires/étiologie , Résultat thérapeutique
10.
Clin Cardiol ; 47(6): e24297, 2024 Jun.
Article de Anglais | MEDLINE | ID: mdl-38873862

RÉSUMÉ

BACKGROUND: Elevated serum uric acid (sUA) is associated with heart failure (HF). HYPOTHESIS: Urate-lowering therapy (ULT) in HF is associated with lower risk of HF hospitalization (hHF) and mortality. METHODS: Data on patients with HF and gout or hyperuricemia in the Clinical Practice Research Datalink database linked to the Hospital Episode Statistics and the Office for National Statistics in the United Kingdom were analyzed. Risks of hHF and all-cause mortality or cardiovascular-related mortality by ULT exposure (ULT initiated within ≤6 months of gout or hyperuricemia diagnosis) were analyzed in a propensity score-matched cohort using adjusted Cox proportional hazards regression models. RESULTS: Of 2174 propensity score-matched pairs, patients were predominantly male, aged >70 years, with mean ± standard deviation sUA 9.3 ± 1.8 (ULT-exposed) and 9.4 ± 1.9 mg/dL (ULT-unexposed). At 5 years, ULT-exposed patients had a 43% lower risk of hHF or all-cause mortality (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.51-0.65) and a 19% lower risk of hHF or cardiovascular-related mortality (adjusted HR: 0.81; 95% CI: 0.71-0.92) versus no ULT exposure. CONCLUSION: ULT was associated with reduced risk of adverse clinical outcomes in patients with HF and gout or hyperuricemia over 5 years.


Sujet(s)
Antigoutteux , Défaillance cardiaque , Hyperuricémie , Acide urique , Humains , Hyperuricémie/traitement médicamenteux , Hyperuricémie/sang , Hyperuricémie/épidémiologie , Hyperuricémie/complications , Mâle , Défaillance cardiaque/épidémiologie , Défaillance cardiaque/traitement médicamenteux , Défaillance cardiaque/mortalité , Femelle , Sujet âgé , Royaume-Uni/épidémiologie , Études rétrospectives , Acide urique/sang , Antigoutteux/usage thérapeutique , Facteurs de risque , Adulte d'âge moyen , Marqueurs biologiques/sang , Résultat thérapeutique , Goutte/traitement médicamenteux , Goutte/sang , Goutte/complications , Goutte/épidémiologie , Facteurs temps , Bases de données factuelles , Études de suivi
11.
Med Sci Monit ; 30: e944314, 2024 Jun 12.
Article de Anglais | MEDLINE | ID: mdl-38865287

RÉSUMÉ

BACKGROUND Hyperuricemia, which is common in chronic kidney disease and diabetes mellitus patients, raises health concerns. Febuxostat, a first-line urate-lowering agent, prompts cardiovascular risk questions, especially in high-risk patients. This study compared the effects of febuxostat and allopurinol on cardiovascular risk in diabetes mellitus and chronic kidney disease patients. MATERIAL AND METHODS This retrospective observational cohort study, conducted using Taiwan's National Health Insurance Research Database, focused on patients diagnosed with chronic kidney disease and diabetes between January 2012 and December 2017. The study population was divided into 2 groups: allopurinol users (n=12 901) and febuxostat users (n=2997). We performed 1: 1 propensity score matching, resulting in subgroups of 2997 patients each. The primary outcomes were assessed using a competing risk model, estimating hazard ratios (HR) for long-term outcomes, including the risks of all-cause hospitalization, hospitalization for heart failure, and hospitalization for cardiovascular interventions. RESULTS Febuxostat users, compared to allopurinol users, had higher all-cause hospitalization (HR: 1.33; 95% confidence interval [CI]: 1.25 to 1.42; P<.001), hospitalization for heart failure (HR: 1.62; 95% CI: 1.43 to 1.83; P<.001), and hospitalization for cardiovascular interventions (HR: 1.51; 95% CI: 1.32 to 1.74; P<.001). Moreover, the adverse effects of febuxostat on cardiac health were consistent across most subgroups. CONCLUSIONS Use of febuxostat in patients with diabetes mellitus and chronic kidney disease is associated with higher cardiovascular risks compared to allopurinol. Prudent evaluation is essential when recommending febuxostat for this at-risk group.


Sujet(s)
Allopurinol , Maladies cardiovasculaires , Fébuxostat , Antigoutteux , Hyperuricémie , Insuffisance rénale chronique , Humains , Fébuxostat/usage thérapeutique , Fébuxostat/effets indésirables , Allopurinol/usage thérapeutique , Allopurinol/effets indésirables , Mâle , Femelle , Insuffisance rénale chronique/complications , Insuffisance rénale chronique/traitement médicamenteux , Adulte d'âge moyen , Sujet âgé , Études rétrospectives , Taïwan/épidémiologie , Hyperuricémie/traitement médicamenteux , Hyperuricémie/complications , Antigoutteux/usage thérapeutique , Antigoutteux/effets indésirables , Diabète/traitement médicamenteux , Facteurs de risque , Adulte , Hospitalisation
12.
Int J Rheum Dis ; 27(5): e15165, 2024 May.
Article de Anglais | MEDLINE | ID: mdl-38769820

RÉSUMÉ

OBJECTIVE: To compare the clinical efficacy of febuxostat combined with a low-purine diet versus allopurinol combined with a low-purine diet in the treatment of gout. METHODS: In this prospective controlled trial, 98 gout patients admitted to our hospital from February 2021 to December 2022 were enrolled as study subjects. Patients were randomly assigned to the study group (febuxostat combined with a low-purine diet) and the control group (allopurinol combined with a low-purine diet), with 49 patients in each group. The therapeutic effect was evaluated based on joint function and serum uric acid levels after treatment, and classified into three levels: markedly effective, effective, and ineffective. The levels of inflammatory factors, including tumor necrosis factor-a (TNF-a), cytokine interleukin-1beta (IL-1ß), and interleukin (IL)-18 (IL-18), were collected. The Numeric Rating Scale (NRS) was used to assess the degree of pain in patients. Clinical indicators before and 6 months after treatment were compared between the two groups. RESULTS: There was no statistically significant difference in age and gender between the two groups. After 6 months of treatment, the effective rate in the study group (48 cases, 97.96%) was higher than that in the control group (42 cases, 85.71%), with a statistically significant difference (p = .027). At the same time, the study group had significantly lower levels of serum uric acid (162.39 µmol/L ± 17.23 µmol/L vs. S198.32 µmol/L ± 18.34 µmol/L, p < .001), creatinine (87.39 mmol/L ± 9.76 mmol/L vs. 92.18 mmol/L ± 9.27 mmol/L, p = .014), total cholesterol (3.65 mmol/L ± 0.65 mmol/L vs. 4.76 mmol/L ± 0.73 mmol/L, p < .001), and triglycerides (1.76 mmol/L ± 0.32 mmol/L vs. 2.28 mmol/L ± 0.41 mmol/L, p < .001) compared to the control group, with statistically significant differences (p < .05). After treatment, the levels of inflammatory factors and degree of pain in the study group were significantly lower than those in the control group (all p < .05). During the treatment process, the incidence of adverse reactions in the study group (2 cases, 4.08%) was lower than that in the control group (9 cases, 18.37%), with a statistically significant difference (p = .025). CONCLUSION: Febuxostat combined with a low-purine diet can reduce inflammatory factors and alleviate the degree of pain in gout patients, significantly improving their clinical symptoms.


Sujet(s)
Allopurinol , Fébuxostat , Antigoutteux , Goutte , Acide urique , Humains , Fébuxostat/usage thérapeutique , Fébuxostat/effets indésirables , Mâle , Femelle , Adulte d'âge moyen , Allopurinol/usage thérapeutique , Goutte/traitement médicamenteux , Goutte/sang , Goutte/diagnostic , Antigoutteux/usage thérapeutique , Antigoutteux/effets indésirables , Études prospectives , Résultat thérapeutique , Acide urique/sang , Sujet âgé , Purines/usage thérapeutique , Marqueurs biologiques/sang , Association thérapeutique , Facteurs temps , Adulte , Médiateurs de l'inflammation/sang
16.
Cardiol J ; 31(3): 479-487, 2024.
Article de Anglais | MEDLINE | ID: mdl-38771265

RÉSUMÉ

Xanthine oxidase inhibitors, including allopurinol and febuxostat, are the first-line treatment of hyperuricemia. This meta-analysis investigated the association between urate-lowering therapy and all-cause mortality in different chronic diseases to match its users and non-users in a real-world setting. Overall, 11 studies were included, which reported adjusted hazard ratios for all-cause mortality over at least 12 months. Meta-analysis of all included studies showed no effect of the therapy on all-cause mortality. However, subgroup analyses showed its beneficial effect in patients with chronic kidney disease (14% risk reduction) and hyperuricemia (14% risk reduction), but not in patients with heart failure (28% risk increase). Urate-lowering therapy reduces all-cause mortality among patients with hyperuricemia and chronic kidney disease, but it seems to increase mortality in patients with heart failure and should be avoided in this subgroup.


Sujet(s)
Cause de décès , Hyperuricémie , Xanthine oxidase , Humains , Xanthine oxidase/antagonistes et inhibiteurs , Hyperuricémie/traitement médicamenteux , Hyperuricémie/mortalité , Hyperuricémie/sang , Cause de décès/tendances , Antienzymes/usage thérapeutique , Facteurs de risque , Allopurinol/usage thérapeutique , Antigoutteux/usage thérapeutique , Fébuxostat/usage thérapeutique , Défaillance cardiaque/traitement médicamenteux , Défaillance cardiaque/mortalité , Acide urique/sang , Insuffisance rénale chronique/mortalité , Adulte
17.
Health Expect ; 27(3): e14071, 2024 Jun.
Article de Anglais | MEDLINE | ID: mdl-38742836

RÉSUMÉ

INTRODUCTION: Gout management remains suboptimal despite safe and effective urate-lowering therapy. Self-monitoring of urate may improve gout management, however, the acceptability of urate self-monitoring by people with gout is unknown. The aim of this study was to explore the experiences of urate self-monitoring in people with gout. METHODS: Semistructured interviews were conducted with people taking urate-lowering therapy (N = 30) in a 12-month trial of urate self-monitoring in rural and urban Australia. Interviews covered the experience of monitoring and its effect on gout self-management. Deidentified transcripts were analysed thematically. RESULTS: Participants valued the ability to self-monitor and gain more understanding of urate control compared with the annual monitoring ordered by their doctors. Participants indicated that self-monitoring at home was easy, convenient and informed gout self-management behaviours such as dietary modifications, hydration, exercise and medication routines. Many participants self-monitored to understand urate concentration changes in response to feeling a gout flare was imminent or whether their behaviours, for example, alcohol intake, increased the risk of a gout flare. Urate concentrations were shared with doctors mainly when they were above target to seek management support, and this led to allopurinol dose increases in some cases. CONCLUSION: Urate self-monitoring was viewed by people with gout as convenient and useful for independent management of gout. They believed self-monitoring achieved better gout control with a less restricted lifestyle. Urate data was shared with doctors at the patient's discretion and helped inform clinical decisions, such as allopurinol dose changes. Further research on implementing urate self-monitoring in routine care would enable an evaluation of its impact on medication adherence and clinical outcomes, as well as inform gout management guidelines. PATIENT OR PUBLIC CONTRIBUTION: One person with gout, who was not a participant, was involved in the study design by providing feedback and pilot testing the semistructured interview guide. In response to their feedback, subsequent modifications to the interview guide were made to improve the understandability of the questions from a patient perspective. No additional questions were suggested.


Sujet(s)
Goutte , Entretiens comme sujet , Acide urique , Humains , Goutte/traitement médicamenteux , Mâle , Femelle , Adulte d'âge moyen , Acide urique/sang , Sujet âgé , Australie , Antigoutteux/usage thérapeutique , Gestion de soi , Autosoins , Adulte , Recherche qualitative
18.
Ann Med ; 56(1): 2332956, 2024 Dec.
Article de Anglais | MEDLINE | ID: mdl-38738384

RÉSUMÉ

PURPOSE: It is unknown whether febuxostat can delay the progression of kidney dysfunction and reduce kidney endpoint events. The aim was to evaluate the renoprotective effect of febuxostat in patients with hyperuricemia or gout by performing a meta-analysis of randomized controlled trials (RCTs). METHODS: MEDLINE, Web of science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Randomized Controlled Trials were searched. The main outcomes included kidney events (serum creatinine doubling or progression to end-stage kidney disease or dialysis). The secondary outcomes were the rate of change in the estimated glomerular filtration rate (eGFR) and changes in the urine protein or urine albumin to creatinine ratio from baseline to the end of follow-up. We used random-effects models to calculate the pooled risk estimates and 95% CIs. RESULTS: A total of 16 RCTs were included in the meta-analysis. In comparison with the control group, the patients who received febuxostat showed a reduced risk of kidney events (RR = 0.56, 95% CI 0.37-0.84, p = 0.006) and a slower decline in eGFR (WMD = 0.90 mL/min/1.73 m2, 95% CI 0.31-1.48, p = 0.003). The pooled results also revealed that febuxostat use reduced the urine albumin to creatinine ratio (SMD = -0.21, 95% CI -0.41 to -0.01, p = 0.042). CONCLUSION: Febuxostat use is associated with a reduced risk of kidney events and a slow decline in eGFR. In addition, the urine albumin to creatinine ratio decreased in febuxostat users. Accordingly, it is an effective drug for delaying the progression of kidney function deterioration in patients with gout.Systematic review registration: PROSPERO CRD42021272591.


Sujet(s)
Fébuxostat , Débit de filtration glomérulaire , Antigoutteux , Goutte , Hyperuricémie , Essais contrôlés randomisés comme sujet , Humains , Créatinine/urine , Créatinine/sang , Évolution de la maladie , Fébuxostat/usage thérapeutique , Fébuxostat/pharmacologie , Débit de filtration glomérulaire/effets des médicaments et des substances chimiques , Goutte/traitement médicamenteux , Goutte/complications , Antigoutteux/usage thérapeutique , Hyperuricémie/traitement médicamenteux , Hyperuricémie/complications , Rein/physiopathologie , Rein/effets des médicaments et des substances chimiques , Défaillance rénale chronique/prévention et contrôle , Défaillance rénale chronique/complications
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