Risk of urolithiasis associated with allopurinol versus benzbromarone among patients with gout: a population-based cohort study

苯溴马隆 医学 别嘌呤醇 痛风 内科学 队列 队列研究 非布索坦 高尿酸血症 尿酸
作者
Eun Ha Kang,Anna Shin,Chang Soo Park,Eun Bong Lee,Yun Jong Lee,Gary Curhan,Hyon K. Choi
出处
期刊:Rheumatology [Oxford University Press]
卷期号:63 (9): 2433-2441 被引量:1
标识
DOI:10.1093/rheumatology/keae262
摘要

Abstract Objectives To compare the risk of urolithiasis in gout patients initiating allopurinol, a xanthine oxidase inhibitor, vs benzbromarone, a uricosuric. Methods Using the 2011–20 Korea National Health Insurance Service database, we conducted a cohort study on gout patients initiating allopurinol vs benzbromarone as the first-line urate-lowering treatment. The primary outcome was a new onset urinary stone. The secondary outcome was a stone requiring intervention. We estimated hazard ratios (HRs) and 95% CIs using Cox proportional hazard models with a 5:1 ratio propensity-score matching on >80 variables. Subgroup analyses were done by age, sex, thiazide use and cardiovascular risk. Results 61 300 allopurinol initiators PS-matched on 12 260 benzbromarone initiators were included (mean age 59 years, 79% male). During a mean follow-up of 322 days, 619 urolithiasis cases occurred with an incidence rate of 0.87 per 100 person-years in allopurinol and 1.39 in benzbromarone initiators, showing a HR of 0.64 (95% CI, 0.51–0.80). Approximately 44% of urinary stones required intervention with a HR of 0.61 (95% CI, 0.43–0.88). The lower risk associated with allopurinol compared with benzbromarone persisted across subgroups but was greater in the high than non-high cardiovascular risk subgroup (P for interaction = 0.02) Conclusion This population-based cohort study found that allopurinol compared with benzbromarone was associated with a substantially lower risk of urolithiasis particularly in the presence of the high cardiovascular risk. This finding provides important safety information for clinicians’ decision-making on urate-lowering treatments of different mechanisms of action.
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