痛风管理的国内外指南比较.ppt

1、痛风管理的最新国内 外指南比较 指南名称 制定 时间 制定国家 BSR指南：痛 风 管理 2017 英国 中国痛 风诊疗 指南 2016 中国 ACP临 床 实 践指南：急性和复 发 性痛 风 的管理 2016 美国 EULAR循 证 建 议 ：痛 风 的管理 2016 欧洲 澳大利 亚 和新西 兰 痛 风诊 断和 管理建 议 2015 澳洲 痛 风诊 断与管理的多国 证 据推 荐意 见 2014 14 countries 控制痛风急性发作的用药选择推荐 NSAID and colchicine without contraindications 2017BSR 首选 NSAIDsNSAIDs

2、禁忌建议单独使用低剂量秋水仙碱 对 NSAIDs及秋水仙碱均不耐受建议使用 GC2016中 国 Corticosteroids should be considered as rst-line therapy without contraindications 2016ACP first-line options are colchicine and/or an NSAID, oral corticosteroid or articular aspiration and injection of corticosteroids2016EULAR NSAIDs, colchicine and g

3、lucocorticoids are all effective in management of acute gout; comorbidities and concomitant medications inuence choice 2015澳洲 Colchicine, NSAIDs and/or glucocorticoids depending on comorbidities and risk of adverse effects2014多国 痛风急性发作的用药选择循证证据 疼痛缓解及控制痛风急性发作 ：依托考昔 双氯芬酸、塞来昔布 吲哚美辛 总不良反应、胃肠道不良反应、头晕 ：依托

4、考昔 依托度酸 罗非昔布 双氯芬酸 吲哚美辛 布洛芬 萘普生 COX-2ibs可更有针对抑制 COX-2，减少胃肠道损伤等副作 用，可用于胃肠道高危因素患者。 胃肠道出血风险 ： GC NSAIDs，但无针对关节内注射的GC的相关证据 控制痛风急性发作的药物剂量推荐 NSAID colchicine Corticosteroids 2017BSR maximum dose 0.5 mg bd- qds / 2016中国 / 1.5-1.8mg/d 30mg/d,3d 2016ACP / 1.2 mg followed by 0.6 mg 1 hour later 35 mg/d,5d 2016

5、EULA R / a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 3035 mg/d, 3- 5d 2015澳洲 / low-dose low-dose 2014多国 / 1.8 mg in 24 h / 控制痛风急性发作的用药禁忌 NSAID colchicine Corticosteroids 2017BSR Choice of first line agent will depend on patient preference, renal function and co-morbidities 2016中国

6、 / / / 2016ACP renal disease, heart failure, or cirrhosis renal or hepatic impairment with P450 3A4 inhibitors or P- glycoprotein inhibitors / 2016EUL AR severe renal impairment severe renal impairment; receiving strong P- glycoprotein and/or CYP3A4 inhibitors(such ascyclosporin or clarithromycin )

7、/ 2015澳洲 renal impairment, gastrointestinal disease and diabetes慎用 renal impairment and in patients taking strong CYP3A4 inhibitors减量 renal impairment, gastrointestinal disease and diabetes 慎用 2014多国 Individual treatment decisions should be based on consideration of an individuals characteristics an

8、d each drugs safety prole 控制痛风急性发作的联合用药 In patients with acute gout where response to monotherapy is insufficient, combinations of treatment can be used 2017BSR Recommends considering combination therapy, such as colchicine and an NSAID or colchicine and corticosteroids for patients with particularl

9、y severe acute gout2016EULAR The use of combination therapy was felt to be appropriate in certain situations such as severe or refractory disease or when comorbidities limit the use of individual agents2015澳洲 痛风急性发作后降尿酸治疗的时机 Commencement of ULT is best delayed until inflammation has settled2017BSR r

10、ecommends against initiating long-term ULT in most patients after a rst gout attack or in patients with infrequent attacks2016ACP recommends possible initiation of ULT close to the rst gout attack resolution2016EULAR 降尿酸治疗时预防复发的措施 Colchicine 500 mgs bd or od continued for up to 6 months 2017BSR 预防性使

11、用小剂量 秋水仙碱 3-6个月 )2016中国 prophylactic therapy with low-dose colchicine or low-dose NSAIDs more than 8 weeks2016ACP Recommended prophylactic treatment is colchicine, 0.51 mg/d. If colchicine is not tolerated or is contra-indicated, prophylaxis with NSAIDs at a low dosage2016EULAR NSAIDs, low-dose colc

12、hicine and low-dose glucocorticoid can all be used for prophylaxis, alone or in combination 2015澳洲 use colchicine (0.61.5 mg daily) for the initial 36 months, no evidence on the use of NSAIDs or glucocorticoids as prophylaxis was retrieved 2014多国 降尿酸药物的联合使用 A uricosuric agent can be used in combinat

13、ion with a xanthine oxidase inhibitor in patients who do not achieve a therapeutic serum urate target with opti- mal doses of monotherapy2017BSR 别嘌醇联合苯溴马隆对溶解痛风石比单用苯溴马隆效果更好 2016中国 Uricosurics are recommended combination with allopurinol in patients without proper control with allopurinol alone(probenecid-allopurinol or benzbromarone-allopurinol) 2016EULAR The combination of allopurinol and benzbromarone allowed a reduction in SUA levels except in cases of severe renal dysfunction 2014多国 THANK YOU ！