A retrospective observational study of the appropriate starting dose of febuxostat in patients with gout
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Background/Aims: The occurrence of gout attacks at the start of uric acid lowering treatment worsens compliance. We aimed to determine the appropriate dose of febuxostat to reduce the occurrence of gout attacks during the initial treatment period. Methods: We retrospectively analyzed the data of patients diagnosed with gout who underwent treatment at Jeju National University Hospital between May 2018 and May 2020. Results: Two-hundred and twenty-seven patients were included, with a mean age of 53.2 ± 16.4 years, and 219 (96.5%) were male. The patients were divided into two groups according to the starting dose of febuxostat (20 mg vs. 40 mg). There were no significant differences in mean age, disease duration, colchicine, estimated glomerular filtration rate (eGFR), initial uric acid levels, and presence of subcutaneous tophi between the two groups. Gout attacks occurred more frequently in the 20 mg group than in the 40 mg group during the first 3 months of treatment (32.0% vs. 14.3%, p = 0.002), particularly CKDduring the first month (21.3% vs. 7.5%, p = 0.005). Multivariate logistic regression analysis was conducted adjusting for the effects of disease duration, the presence of subcutaneous tophi, eGFR, and initial uric acid levels. A febuxostat starting dose of 40 mg (odds ratio, 0.464; 95% confidence interval [CI], 0.246 to 0.862; p = 0.015) and anti-inflammatory prophylaxis (odds ratio, 0.359; 95% CI, 0.158 to 0.813; p = 0.014) were found to be independent factors associated with a gout attack. Conclusions: Starting uric acid lowering treatment with febuxostat 40 mg rather than 20 mg may reduce the incidence of gout attacks in the early period of treatment in Korean patients with gout.
Abstract
Background/Aims: The occurrence of gout attacks at the start of uric acid lowering treatment worsens compliance. We aimed to determine the appropriate dose of febuxostat to reduce the occurrence of gout attacks during the initial treatment period. Methods: We retrospectively analyzed the data of patients diagnosed with gout who underwent treatment at Jeju National University Hospital between May 2018 and May 2020. Results: Two-hundred and twenty-seven patients were included, with a mean age of 53.2 ± 16.4 years, and 219 (96.5%) were male. The patients were divided into two groups according to the starting dose of febuxostat (20 mg vs. 40 mg). There were no significant differences in mean age, disease duration, colchicine, estimated glomerular filtration rate (eGFR), initial uric acid levels, and presence of subcutaneous tophi between the two groups. Gout attacks occurred more frequently in the 20 mg group than in the 40 mg group during the first 3 months of treatment (32.0% vs. 14.3%, p = 0.002), particularly CKDduring the first month (21.3% vs. 7.5%, p = 0.005). Multivariate logistic regression analysis was conducted adjusting for the effects of disease duration, the presence of subcutaneous tophi, eGFR, and initial uric acid levels. A febuxostat starting dose of 40 mg (odds ratio, 0.464; 95% confidence interval [CI], 0.246 to 0.862; p = 0.015) and anti-inflammatory prophylaxis (odds ratio, 0.359; 95% CI, 0.158 to 0.813; p = 0.014) were found to be independent factors associated with a gout attack. Conclusions: Starting uric acid lowering treatment with febuxostat 40 mg rather than 20 mg may reduce the incidence of gout attacks in the early period of treatment in Korean patients with gout.
참고문헌 (16)
- Dehlin M, "Global epidemiology of gout : prevalence, incidence, treatment patterns and risk factors", Nat Rev Rheumatol, 16, pp.380~390 (2020)
- Shoji A, "A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis : evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy", Arthritis Rheum, 51, pp.321~325 (2004)
- Dalbeth N, "Mechanisms of bone erosion in gout : a quantitative analysis using plain radiography and computed tomography", Ann Rheum Dis, 68, pp.1290~1295 (2009)
- Deeks ED, "Lesinurad : a review in hyperuricaemia of gout", Drugs Aging, 34, pp.401~410 (2017)
- Choi HK, "Independent impact of gout on mortality and risk for coronary heart disease", Circulation, 116, pp.894~900 (2007)
- Abbott RD, "Gout and coronary heart disease : the Framingham study", J Clin Epidemiol, 41, pp.237~342 (1988)
- Yun-Hong Cheon, "What is the Best Choice for Urate-lowering Therapy for Korean?", 대한류마티스학회지, 27(2), pp.78~87 (2020), 대한류마티스학회[DOI]
- FitzGerald JD, "2020 American College of Rheumatology guideline for the management of gout", Arthritis Care Res(Hoboken), 72, pp.744~760 (2020)
- Pittman JR, "Diagnosis and management of gout", Am Fam Physician, 59, pp.1799~1810 (1999)
- Feng X, "Prophylaxis on gout flares after the initiation of urate-lowering therapy : a retrospective research", Int J Clin Exp Med, 8, pp.21460~21465 (2015)
- Keenan RT, "Limitations of the current standards of care for treating gout and crystal deposition in the primary care setting : a review", Clin Ther, 39, pp.430~441 (2017)
- Neogi T, "2015 Gout classification criteria : an American College of Rheumatology", European League Against Rheumatism collaborative initiative, 2015, pp.67, 2557~2568
- 서미혜, "2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea", Journal of Obesity & Metabolic Syndrome, 28(1), pp.40~45 (2019), 대한비만학회[DOI]
- Perez-Ruiz F, "Improving adherence to gout therapy : an expert review", Ther Clin Risk Manag, 14, pp.793~802 (2018)
- Abhishek A, "Association of serum uric acid and disease duration with frequent gout attacks:a case-control study", Arthritis Care Res(Hoboken), 68, pp.1573~1577 (2016)
- Rothenbacher D, "Frequency and risk factors of gout flares in a large population-based cohort of incident gout", Rheumatology(Oxford), 50, pp.973~981 (2011)