目的:关于pegloticase停药后的长期临床结果或降低尿酸(ULT)治疗的使用知之甚少。我们检查了ULT的使用,血清尿酸(SU),炎症生物标志物,Pegloticase停药后的肾功能。
方法:我们在2016年1月至2022年6月6日使用Rheumatology信息学有效性系统(RISE)注册表对停用pegloticase的痛风患者进行了回顾性分析。我们将停药定义为最后一次输注后≥12周的间隙。我们检查了最后一次给药后两周开始的结果,并确定了pegloticase停药后的ULT治疗。我们评估了实验室值的变化(SU,eGFR,CRP和ESR),将治疗中(第二次pegloticase剂量≤15天)与治疗后进行比较。
结果:在375例痛风患者中,停药后实验室变化中位数(IQR)为:SU:+2.4mg/dL(0.0,6.3);eGFR:-1.9mL/min(-8.7,3.7);CRP:-0.8mg/L(-12.8,0.0);ESR:-4.0mm/hr(-13.0,0.0).停药后的治疗包括口服ULT(86.0%),重新启动pegloticase(4.5%),没有ULT的文件(9.5%),排除多个同日处方的患者(n=17)。pegloticase后口服ULT为:62.7%别嘌醇,34.1%非布索坦。开始/重新启动ULT的中位数(IQR)时间为92.0天(55.0,173.0)。ULT处方后(≥30天),只有51.0%的患者SU<6mg/dL。重新启动pegloticase的患者中SU为0.9mg/dL(IQR:0.2,9.7),58.3%的患者SU<6mg/dL。
结论:Pegloticase治疗黄嘌呤氧化酶抑制剂无效的痛风患者,但是在停止的患者中,最佳治疗方法尚不清楚。基于这一分析,只有一半的人开始另一个ULT达到目标SU。需要密切随访以优化pegloticase停药后的结果。
OBJECTIVE: Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation.
METHODS: We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment.
RESULTS: Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (- 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions (n = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU < 6 mg/dL. Patients restarting pegloticase achieved a median SU of 0.9 mg/dL (IQR:0.2,9.7) and 58.3% had an SU < 6 mg/dL.
CONCLUSIONS: Pegloticase treats uncontrolled gout in patients with failed response to xanthine oxidase inhibitors, but among patients who discontinue, optimal treatment is unclear. Based on this analysis, only half of those starting another ULT achieved target SU. Close follow-up is needed to optimize outcomes after pegloticase discontinuation.