痛风急性发作一线药物治疗方案的系统评价及药物经济学分析  

First-line drug therapies for treating acute gout flares:a systematic review and pharmacoeconomic analysis

作　　者：张超凤 刘晓莉 李雪娟 林琦[3] 林海滨[4] ZHANG Chao-feng;LIU Xiao-li;LI Xue-juan;LIN Qi;LIN Hai-bin(Putian UniversityDepartment of Hematology and Rheumatology,the Affiliated Hospital,Putian 351100,China;Putian University School of Pharmacy and Medical Technology,Putian 351100,China;Putian University Department of Pharmacy,the Affiliated Hospital,Putian 351100,China;Putian University Department of Orthopedics,the Affiliated Hospital,Putian 351100,China)

机构地区：[1]莆田学院附属医院血液风湿科,莆田351100 [2]莆田学院药学与医学技术学院,莆田351100 [3]莆田学院附属医院药学部,莆田351100 [4]莆田学院附属医院骨科,莆田351100

出　　处：《中国新药杂志》2021年第16期1530-1536,共7页Chinese Journal of New Drugs

基　　金：福建省卫生计生青年科研课题资助项目(2017-2-79);福建省教育厅中青年教师教育科研立项项目(JAT190562);莆田市科技计划项目(2018S3F006,2019S3F002);莆田学院校级教育教学改革研究立项项目(JG202048)。

摘　　要：系统评价非甾体抗炎药(NSAIDs)、选择性COX-2受体抑制剂(COXIBs)、糖皮质激素(GC)及秋水仙碱(COLC)治疗痛风急性发作的有效性、安全性与经济性。方法:检索Medline, Embase, CENTRAL,CBM,CNKI等文献数据库,检索NSAIDs, COXIBs, GC及COLC比较治疗痛风急性发作的随机对照试验,检索时间均为从建库至2021年3月。根据纳入与排除标准进行文献筛选、资料提取和质量评价,采用R统计软件进行Meta分析,并进行药物经济学分析。结果:共纳入19篇文献,含2 598例患者。网状Meta分析表明NSAIDs, COXIBs与GC均能有效缓解患者疼痛,改善致病关节红肿的情况(P<0.05);COLC的不良事件发生率最高(P<0.05),选择NSAIDs, COXIBs与GC等3种治疗方案进行最小成本分析,其中GC最具性价比。结论:NSAIDs, COXIBs, GC与COLC均能有效治疗痛风急性发作,GC为最经济的治疗方案。Objective:To evaluate the efficacy,safety and economy of nonsteroidal anti-inflammatory drugs(NSAIDs),selective cycleooxygenase-2 receptor inhibitors(COXIBs),glucocorticoids(GC),and colchicine(COLC)in the treatment of acute gout flare by Meta-analysis.Methods:Literature about randomized controlled trails(RCT)using NSAIDs,COXIBs,GC and COLC in the treatment of acute gout flare was searched through Medline,Embase,CENTRAL,CBM and CNKI up to Mar.2021 and then screened according to the inclusion and exclusion criteria.The data was extracted and assessed for the methodological quality of included studies.Then,Meta-analysis was performed by using R programming and pharmacoeconomics analysis was conducted.Results:A total of 19 RCTs involving 2598 patients were included.The results of network Meta-analysis showed that NSAIDs,COXIBs and GC could alleviate patients' pain effectively and improve study joint swelling(P<0.05).COLC had the highest incidence of adverse events among the four kinds of therapeutic drugs.Cost-minimization analysis showed that GC was the most economical treatment.Conclusion:NSAIDs,COXIBs,GC and COLC can effectively treat acute gout flare,and GC treatment is the most economical.

关 键 词：痛风急性发作期 非甾体抗炎药 选择性COX-2受体抑制剂 糖皮质激素 秋水仙碱 药物经济学 

分 类 号：R969.3[医药卫生—药理学] K971.1[医药卫生—药学]