ABSTRACT
RESUMEN Objetivo: Identificar las características clínicas de los pacientes con gota y la forma de utilización de los medicamentos antigotosos en Colombia. Métodos: Estudio de corte transversal en el que se analizaron 310 historias clínicas de pacientes atendidos en el último trimestre del 2016 y que recibieron un medicamento antigotoso. Se identificaron variables sociodemográficas, clínicas, farmacológicas, comorbilidades y paraclínicas. Para cada medicamento antigotoso se determinó si el uso fue según las recomendaciones aprobadas por la Federal Drug Administration (FDA). Se realizaron análisis descriptivos, bivariados y multivariados. Resultados: Se evaluaron pacientes de 14 diferentes ciudades de Colombia, con un predominio masculino del 70,3% (n = 218) y una mediana de edad de 64 arios (RIC: 26-94 arios). El antigotoso más frecuentemente utilizado fue alopurinol (n = 255; 82,3%), seguido de colchicina (n = 54; 17,4%). Los diagnósticos hallados como indicación fueron: hiperuricemia (n = 181; 58,4%), gota (n = 34; 11%), artritis gotosa (n = 28; 9%). El 74,5% (n = 231) de las prescripciones tenía un uso aprobado según la FDA, especialmente alopurinol en el manejo de gota e hiperuricemias, mientras que colchicina se encontró siendo utilizada en indicaciones no aprobadas (n = 44; 81,4%). Las comorbilidades más frecuentes fueron hipertensión (68,4%) y dislipidemia (55,8%). Conclusiones: Los pacientes con gota en tratamiento farmacológico tienen una elevada frecuencia de comorbilidades cardiovasculares, y están siendo tratados con alopurinol para la prevención a largo plazo, mientras que una menor proporción recibe colchicina que comúnmente es utilizada para indicaciones no aprobadas por las agencias reguladoras.
ABSTRACT Objective: To identify the clinical characteristics of patients with gout, and the prescription patterns of anti-gout medications in Colombia. Methods: Cross-sectional study, that analysed the data from 310 medical records of patients treated in the last quarter of 2016, and who received an anti-gout medication. Sociodemographic, clinical, pharmacological, comorbidities, and paraclinical variables were identified. For each anti-gout drug used, it was determined whether the use was in accordance with Federal Drug Administration (FDA) approved recommendations. Descriptive, bivariate and multivariate analyses were performed. Results: Patients from 14 different cities in Colombia were evaluated, with a male predominance of 70.3% (n = 218) and a median age of 64 years (RIC: 26-94 years). The most frequently used anti-gout medication was allopurinol (n = 255; 82.3%), followed by colchicine (n = 54; 17.4%). The main diagnoses found as an indication were: hyperuricaemia (n=181, 58.4%), gout (n = 34; 11.0%), and gouty arthritis (n = 28; 9.0%). Almost three-quarters (74.5%; n = 231) of the prescriptions had an approved use according to the FDA, especially allopurinol in the management of gout and hyperuricaemia, while colchicine was found to be used in unapproved indications (n = 44, 81.4%). The most frequent comorbidities were hypertension (68.4%) and dyslipidaemia (55.8%). Conclusions: Patients with gout who are under pharmacological treatment have a high frequency of cardiovascular comorbidities. They were being treated with allopurinol for long-term prevention, while a smaller proportion received colchicine, which is often used for indications not approved by regulatory agencies.
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Pharmaceutical Preparations , Colombia , Gout , Therapeutics , Colchicine , Multivariate Analysis , Diagnosis , PrescriptionsABSTRACT
Objective To investigate the clinical effect ofYishen-Lishi formula combined with conventional treatment for gouty nephropathy.MethodsA total of 118 patients with gout nephropathy were included and divided randomly into a conventional treatment group (n=60) and a combined treatment group (n=58) according to the random number table method. The patients in the conventional treatment group were treated with allopurinol and those in the combined treatment group were treated with allopurinol and Yishen-Lishi formula, both for 3 months. Serum uric acid, blood urea nitrogen (BUN), serum creatinine (SCr), 24 h endogenous creatinine clearance (CCr), 24 h urine protein, urineb2 microglobulin, serum triacylglycerol (TG), serum total cholesterol (TC), serum apolipoprotein A1, 24 h urine volume and urine pH were determined. The therapeutic effect was evaluated.ResultsThe urine pH (6.43 ± 0.6vs.6.21 ± 0.4;t=2.351,P=0.020), 24 h urine volume (3.3 ± 0.4vs.2.8 ± 0.6 L;t=5.308,P<0.001), 24 h CCr (1.61 ± 0.11 ml/svs. 1.33 ± 0.10 ml/s;t=14.477,P<0.001) and serum apolipoprotein A1 (1.90 ± 0.40 g/Lvs. 1.01 ± 0.33 g/L;t=13.203,P<0.01) in the combined treatment groupwere significantly higher than those in the standard treatment group. The serum uric acid (312.01 ± 33.56mmol/Lvs.350.12 ± 35.21 mol/L;t=6.015,P<0.001), BUN (6.22 ± 0.91 mmol/Lvs.11.50 ± 4.01 mmol/L;t=9.586,P<0.001), SCr (87.32 ± 13.90mmol/Lvs.122.54 ± 18.37mmol/L;t=11.743,P<0.001), 24 h urine protein (0.7 ± 0.2 gvs.1.2 ± 0.5 g;t=7.087,P<0.001), urineb2 microglobulin (220.3 ± 90.3mg/Lvs.330.1 ± 90.1mg/L;t=6.611,P<0.01), serum TG (5.11 ± 0.50 mmol/Lvs.6.30 ± 0.50 mmol/L;t=12.923,P<0.001), serum TC (1.50 ± 0.50 mmol/Lvs.2.30 ± 0.52 mmol/L;t=8.689,P<0.001) in the combined treatment group were significantly higher than those in the standard treatment group. The total effective rate inthe standard treatment group was significantly higher than those in the standard treatment group (89.7%vs.70.0%;χ2=5.871,P=0.015). ConclusionYishen-Lishi formula combined with conventional treatmentmay protect renal function, and reduce the blood lipids, its therapeutic effect is superior to conventional treatment alone in patients with gouty nephropathy.
ABSTRACT
Objective To evaluate the efficacy and safety of etoricoxib and meloxicam in the treatment of patients with acute gout. Methods A randomized,active comparator study was conducted at outpatients and inpatients in our hospital from January 2009 to July 2010.A total of 84patients aged (63.7± 11.0) years with an acute attack of gout were treated with etoricoxib 120 mg/d (n =48),or meloxicam 15 mg/d (n =36) for 7 d.The patient's assessment of joint pain (0- 4 point Likert scale) at drug treatment for 2-5 d was considered as the primary efficacy end point,4 h after firstly takiug the drug and 2-8 d after treatment as the secondary efficacy end point.The starting efficacy was determined until pain relieved by patient himself. The safety was assessed by adverse experiences and indexes including leucocyte, platelet,crcatinine, uric acid,alanine transaminase (ALT),aspartate transaminase (AST) and mean artery pressure(MAP). Results In 84 patients,3cases (8.3％) in meloxicam treatment and 15 cases (31.2％) in etoricoxib treatment (among which 13 cases finished treatment) discontinued therapy.The improvement scores of joint pain were (-0.41 ±0.35 vs.-0.19±0.30,P=0.005) at4 h after firstly taking the drug,(-1.66±0.58 vs. 1.38±0.44,P=0.018)at drug treatment for 2 -5 d,( - 1.83 ± 0.60 vs.- 1.85 ± 0.53,P=0.9) at 2 8 d after treatment,and (-2.64±0.45 vs. - 2.38±0.37,P=0.000) post-treatment higher than pre treatment.The starting time of pain relieving were (4.0 ± 4.6) h in etoricoxib treatment and (12.1±5.7) h in meloxicam treatment. The levels of leucocyte were decreased after treatment as compared with before treatment in both two drug treatments(P＜0.05),while no differences were found in platelet.creatinine,uric acid,ALT and AST.MAP after etoricoxib treatment was increased compared with pretreatment ( P ＜ 0.05 ). Drug related adverse experiences appeared in 15 cases (31.2 ％ ) in etoricoxib treatment and 12 cases(33.3 ％ ) in meloxicam treatment(P=1.000).The ratio of gastrointestinal tract-related adverse effects in meloxicam treatment was higher than in etoricoxib (22.2％ vs.6.2％,P＜ 0.05),while adverse effects on cardiovascular in etoricoxib treatment were comparable to that of meloxicam (16.7 ％ and 11.1 ％,P＞0.05). Conclusions Etoricoxib at a dose of 120 mg once daily may be more effective than meloxicam for acute gout in aspects of safety and tolerance.