Objective To compare the efficacy and safety of benzbromarone vs. allopurinol for primary gout. Methods Searching PubMed, Cochrane Library, EMbase, CNKI, VIP and CBM, randomized controlled trials were collected and the quality of RCTs was evaluated using Cochrane systematic review. Meta-analysis was performed. Results 6 RCTs were included in this study,with a total of 350 patients. Meta-analysis showed that there was no statistical significance in total effective rate between two groups (Pgt;0.05). 4 RCTs were enrolled in comparison of ADR. There was statistical significance between two groups (Plt;0.05). Conclusion There is no significant difference in the efficacy between benzbromarone and allopurinol for the primary gout.But benzbromarone is safe than allopurinol for primary gout .
Gout is caused by abnormal metabolism of purine. Its most common symptom attack of intense pain and swelling in the joints. Attacks of gout can according to the alteration if it is in acute interval periods. How can we get the optimal effect? The development of methodology has provided much convincing evidence for us to choose the most appropriate treatment.
摘要:目的: 系统评价非布索坦治疗痛风的疗效及安全性。 方法 :计算机检索PubMed、EMBASE、SCI、CBM、CNKI、VIP、万方数据库及Cochrane图书馆,手工补充检索;纳入非布索坦治疗痛风的随机对照试验(RCT);进行方法学质量评价和Meta分析。 结果 :共纳入3个RCT(受试者1985例),A级文献1篇,B级文献2篇。Meta分析结果显示:最后3月血清尿酸(SU)持续低于60 mg/dl患者数、随访结束时SU低于60 mg/dl患者数非布索坦组与对照组差异均有统计学意义;治疗相关不良事件发生数与安慰剂组差异无统计学意义,与别嘌呤组差异有统计学意义。 结论 :基于当前证据,非布索坦治疗痛风,能有效降低SU含量,减少治疗相关不良事件发生率。Abstract: Objective: Assessing the effectiveness and safety of febuxostat for the treatment of gout. Methods :Randomized controlled trails(RCT) of febuxostat for the treatment of gout were gathered from the Cochrane Library、PubMed、EMBASE、SCI、CBM、CNKI、VIP、Wangfang Database, other relative researches were handsearched, each RCT was methodological quality evaluated, then analyzed by software RevMan50 Results :A total of 3 RCTs were collected (involving 1985 subjects); 1 was graded A, 2 were B; according to the Metaanalysis: the differences of subjects with last 3 monthly serum urate(SU)＜60mg/dl and subjects with SU＜60mg/dl at final visits were significant; treatmentrelated adverse events between febuxostat and allopurinol was significant different, but not significant difference between febuxostat and placebo. Conclusion : According to the evidence currently, febuxostat could reduce SU and the episodes of treatmentrelated adverse events.
ObjectiveTo observe the efficacy and safety of colchicine combined with etofenamate cream in the treatment of acute gouty arthritis. MethodsA total of 150 patients diagnosed with acute gouty arthritis from June 2013 to July 2014 were equally randomized to receive colchicine alone (group A), colchicine with etofenamate cream (group B) and colchicine with etoricoxib (group C). The assessment on joint pain, tenderness, health quality and clinical efficacy of patients in each group was carried out, and the results were compared before and 7 days after the treatment. ResultsBecause of adverse events, the number of patients who withdrew from group A, B and C was respectively 2, 3 and 7. So the actual number of patients completing the study was 48 for group A, 47 for group B and 43 for group C. The patients' and physicians' assessments of mean change in pain intensity from baseline over days 1-7 were comparable in each group, with no statistical significance between groups (P>0.05). The patients' assessment of response to treatment was the highest in the colchicine with etofenamate cream group, and the differences compared with other two groups were significant (P=0.012 and 0.025, respectively). The physicians' global assessment of response to treatment showed no statistical significance between groups (F=0.021, P=0.908). The joint tenderness was most improved in colchicine with etoricoxib group, and the differences compared with other two groups were significant (P=0.041 and 0.034, respectively). The assessments of health quality were similar between groups. The C-reactive protein and erythrocyte sedimentation rate were decreased at study-end in all groups, but statistically significant differences were only found between group A and C (P<0.05). The incidence rate of adverse events was the highest in colchicine with etoricoxib group and the difference from other two groups was significant (P<0.05). ConclusionColchicine with etofenamate cream is as effective as colchicine with etoricoxib for treating acute gout and may have a better safety and tolerability profile.
ObjectiveTo optimize the extracting process of Zipu gouty mixture by orthogonal experiment, and to provide theoretical basis for its preparation procedure and quality control. MethodsThe water drawn extract yield and the total content of the chlorogenic acid were considered as research indexes. The orthogonal test was conducted to evaluate the effects of three factors including the amount of material/solvent ratio, extraction times, and duration of sample extraction of Zipu gouty mixture extracting process. ResultsThe extracting process was optimized with the material/solvent ratio of 1:8, extract time of 30 minutes for 3 cycles. ConclusionThe Zipu gouty mixture extracting process optimized by orthogonal test is simple, reliable and easy to repeat, which provides a theoretical basis for large-scale production.
ObjectivesTo compare the efficacy and economy of febuxostat and allopurinol in the treatment of chronic gout, and to provide reference for clinical rational drug use.MethodsThe Markov model was established to conduct cost-effectiveness analysis for febuxostat and allopurinol serving as the front-line treated medicines. In view of the uncertainty of model parameters, single factor, probability sensitivity analysis and other methods were used to analyze the stability of the results.ResultsThe cost of the therapeutic schedule of allopurinol 300 mg was lower than febuxostat 40 mg, and it saved RMB 4 339.6 Yuan for each patients on average, while obtained 0.067 more QALY. Uncertainty analysis revealed that only those utility value which could not reach the standard influenced the final results in all included variable elements. When the aspiration payment value was zero, the percentage of therapeutic schedule for allopurinol 300 mg was 100. With the increase of aspiration payment value, the probability for febuxostat scheme becoming the superior one showed a very gradual growth. When the aspiration payment value reached 150 000, the probability still remained under 10%.ConclusionsAllopurinol is more economical than finasteride as the first choice in the treatment of chronic gout. Therefore, it is recommended that allopurinol should be used as the first-line drug for economical considerations.
ObjectiveTo explore the clinical characteristics, clinical classification, and treatment of wrist gouty arthritis. Methods The clinical data of 24 patients with wrist gouty arthritis and complete follow-up between April 2011 and August 2020 were retrospectively analyzed. There were 21 males and 3 females; the first onset age was 21-72 years, with a median age of 50 years. There were 15 cases of simple wrist joint disease, and 9 cases of other joints (hand, knee, ankle, metatarsophalangeal joint) involvement; 19 cases of wrist joint as the first site. Except for 1 patient with a medical history of 21 years, the time from onset to diagnosis in the remaining 23 patients was 7 days to 9 years, with a median time of 2 months. According to the clinical manifestations, imaging manifestations, lesion range, and intraoperative wrist arthroscopy manifestations of wrist gouty arthritis, they were classified into 5 types from mild to severe. Among the 24 patients, 13 were type Ⅰ, 2 were type ⅡA, 3 were type ⅡB, 2 were type ⅢA, 3 were type Ⅳ, and 1 was type Ⅴ. The time from first onset to diagnosis for type Ⅰ and type Ⅱ patients was (12.7±40.1) months, and for type Ⅲ-Ⅴ patients was (152.0± 88.5) months, the difference was significant (t=−4.355, P=0.001). Thirteen patients with type Ⅰ received conservative treatment (including diet, exercise, lifestyle intervention, and medication), and 11 patients with type Ⅱ-Ⅴ received surgical treatment (including 1 case of arthroscopic synovial membrane and gout crystal clearing, 1 case of ligament repair, 5 cases of lesion debridement/artificial bone grafting and filling, 3 cases of wrist fusion, and 1 case of tophicectomy). Before and after treatment, the visual analogue scale (VAS) score was used to evaluate the improvement of wrist joint pain; and the range of motion of the wrist joint (including palmar flexion, dorsal extension, radial deviation, and ulnar deviation) was evaluated. ResultsThirteen conservatively treated patients were followed up 10 months to9 years, with an average of 2.2 years. The VAS scores before treatment and at last follow-up were 6.8±0.7 and 2.9±0.9, respectively, and the difference was significant (t=12.309, P=0.000). During follow-up, there was no wrist bone and wrist joint damage; wrist joint range of motion basically reached normal. At last follow-up, the wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation significantly improved when compared with the values before treatment (P<0.05). Eleven surgically treated patients were followed up 5 months to 9 years, with an average of 4.9 years. The swelling and pain of all patients fully relieved, and the VAS scores were 7.3±0.8 before operation, 2.7±0.6 at 1 month after operation, and 2.5±0.6 at last follow-up, which significantly improved after operation (P<0.05); there was no significant difference between 1 month after operation and last follow-up (P>0.05). Excluded 3 patients who underwent wrist fusion, the other 8 patients had significantly improved wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation at last follow-up (P<0.05). The patient’s subjective satisfaction with the surgical results reached 100%. Conclusion A missed diagnosis or misdiagnosis of wrist gouty arthritis will greatly damage the wrist stability and functions. Early and proper interventions can effectively retard the progress of the disease. For the late-stage cases, a staged surgical protocol is recommended.