非布索坦治疗期间要注意什么事项？

We all know that it is used in the treatment of chronic hyperuricemia (gout). Gout Attacks An increase in the frequency of gout attacks is common during the initial stages of taking febuxostat. This is because blood uric acid concentration decreases, leading to mobilization of urate deposited in tissues. To prevent gout attacks during the initial stages of treatment, it is recommended to take nonsteroidal anti-inflammatory drugs or colchicine at the same time. If gout attacks during febuxostat treatment, there is no need to discontinue febuxostat treatment. Gout should be treated accordingly according to the patient's specific situation. So what should we pay attention to during the treatment of gout with febuxostat? Let's take a look.

Cardiovascular events In randomized controlled studies, patients treated with febuxostat had a higher rate of cardiovascular thrombotic events (including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) than allopurinol, with febuxostat being 0.74/100 patient-years (95%CI: 0.36-1.37) and allopurinol being 0.60/100 patient-years (95%CI: 0.16-1.53). A causal relationship between febuxostat and cardiovascular thrombotic events has not been established. Pay attention to monitor the symptoms and signs of myocardial infarction and stroke when taking the medication. Although there is insufficient information within these reports to establish a causal relationship between them. In randomized controlled studies, it was observed that transaminases could increase to more than 3 times the upper limit of normal range (ULN) (the incidence rates in febuxostat and allopurinol treatment groups were AST: 2%, 2%; ALT: 3%, 2%). 

  There was no dose-response relationship for these aminotransferase elevations. Patients should have a liver function test (serum alanine aminotransferase, aspartate transferase, alkaline phosphatase, and total bilirubin) performed before first starting febuxostat and use this result as a baseline level. Patients who report symptoms such as fatigue, loss of appetite, right upper quadrant discomfort, soy-colored urine, or jaundice that may indicate liver damage should undergo prompt liver function testing. 

On the clinical side, if a patient is found to have abnormal liver function (ALT more than 3 times the upper limit of the reference range), the medication should be discontinued and investigated to determine the possible cause. Febuxostat should not be reintroduced in these patients who have abnormal liver function tests and no other reasonable explanation. If the patient's serum ALT exceeds more than 3 times the reference range, and the serum total bilirubin exceeds more than 2 times the reference range, and other causes are excluded, the patient is at risk of severe drug-induced liver damage, and these patients should not restart febuxostat. 

The above are the things we need to pay attention to when treating gout. We hope it can help you.