Abstract | Posljednjih dvadeset godina u razvijenim zemljama prati se rast broja bolesnika s
asimptomatskom hiperuricemijom i rast broja bolesnika kojima su uvedeni lijekovi za
snižavanje urata kod asimptomatske hiperuricemije. Trenutno važeće smjernice European
League Against Rheumatism (EULAR) iz 2016. godine i američke smjernice 2020 American
College of Rheumatology Guideline for the Management of Gout (ACR) također ne preporučuju
uvođenje lijekova za snižavanje urata kod asimptomatske hiperuricemije. Kod bolesnika starije
životne dobi, koji imaju velik broj komorbiditeta i uzimaju velik broj lijekova to predstavlja
dodatan problem jer se povećava rizik interakcija lijekova i nuspojava.
Ciljevi istraživanja: Utvrditi udio bolesnika s asimptomatskom hiperuricemijom u
ukupnom broju bolesnika uključenih u istraživanje, utvrditi jesu li propisanom
farmakoterapijom za snižavanje urata postignute koncentracije mokraćne kiseline u serumu
unutar referentnih vrijednosti i utvrditi potencijalno klinički značajne interakcije lijekova (X,
D i C) koji se koriste u liječenju hiperuricemije s drugom propisanom farmakoterapijom.
Ispitanici i metode: Provedeno je prospektivno istraživanje u periodu od 1. svibnja 2022.
do 31. prosinca 2022. godine u Specijalnoj bolnici za medicinsku rehabilitaciju Varaždinske
Toplice, na odjelu za rehabilitaciju ortopedsko traumatoloških bolesnika. U istraživanje su
uključeni bolesnici stariji od 18 godina s dijagnozom hiperuricemije, gihta i/ili uratne
nefrolitijaze koji u farmakoterapiji imaju, pored lijekova za snižavanje urata, još barem jedan
lijek. Iz medicinske dokumentacije bolesnika uzeti su opći podaci koji uključuju dob i spol,
postavljene dijagnoze, propisanu farmakoterapiju i koncentraciju mokraćne kiseline u serumu.
Unutar 24 sata od zaprimanja bolesnika, uz potpisani informirani pristanak, proveden je
razgovor i uzeta najbolja moguća medikacijska povijest. Za utvrđivanje potencijalnih klinički
značajnih interakcija lijekova korištena je baza podataka Lexi-Comp®Online.
Rezultati: U istraživanje je uključeno 58 bolesnika prosječne starosti 75 godine, od čega
53,4 % muškaraca. Bolesnicima su ukupno propisana 623 lijeka što je 10,7 lijekova po
bolesniku. Ukupno 41,4 % bolesnika je imalo asimptomatsku hiperuricemiju koja je liječena
alopurinolom. Manje od polovice bolesnika (48,3 %) je imalo koncentraciju mokraćne kiseline
u serumu unutar referentnih vrijednosti. Utvrđeno je 95 potencijalno klinički značajnih
interakcija alopurinola stupnja D i C kliničke značajnosti s drugim propisanim lijekovima, što
iznosi 1,8 potencijalno klinički značajnih interakcija alopurinola po bolesniku. Udio interakcija
lijekova stupnja značajnosti D iznosio je 12,6 %, a stupnja značajnosti C 87,4 %. Kod bolesnika
koji su u farmakoterapiji imali propisan febuksostat nisu utvrđene potencijalne klinički
značajne interakcije lijekova.
Zaključak: Uvođenje farmakoterapije za snižavanje urata kod bolesnika s
asimptomatskom hiperuricemijom povećava se rizik od nuspojava i klinički značajnih
interakcija lijekova čime se može ugroziti sigurnost bolesnika. Više od polovice bolesnika koji
su primali farmakoterapiju za snižavanje urata nije imalo koncentraciju mokraćne kiseline u
serumu unutar referentnih vrijednosti. Rezultati ukazuju na važnost optimizacije
farmakoterapije kod bolesnika s hiperuricemijom. |
Abstract (english) | In the last twenty years, in developed countries, there has been an increase in the number of
patients with asymptomatic hyperuricemia and an increase in the number of patients who were
introduced to urate-lowering drugs for asymptomatic hyperuricemia. The currently valid
guidelines of the European League Against Rheumatism (EULAR) from 2016 and the 2020
American College of Rheumatology Guideline for the Management of Gout (ACR) also do not
recommend the introduction of urate-lowering drugs in asymptomatic hyperuricemia. In elderly
patients, who have a large number of comorbidities and take a large number of medications,
this represents an additional problem because the risk of drug interactions and side effects
increases.
Research Objectives: To determine the proportion of patients with asymptomatic
hyperuricemia in the total number of patients included in the research, to determine whether the
prescribed pharmacotherapy for lowering urate achieved serum uric acid concentrations within
the reference values, and to determine potentially clinically significant drug interactions (X, D
and C) used in treatment hyperuricemia with other prescribed pharmacotherapy.
Patients and methods: A prospective study was conducted in the period from 1 May 2022
until 31 December 2022, in the Special Hospital for Medical Rehabilitation in Varaždinske
Toplica at the Department for Rehabilitation of Orthopedic Trauma Patients. The study
included patients over 18 years of age with a diagnosis of hyperuricemia, gout and/or urate
nephrolithiasis who, in addition to urate-lowering drugs, have at least one other drug in their
pharmacotherapy. General data including age and sex, established diagnoses, prescribed
pharmacotherapy and serum uric acid concentration were taken from the patients medical
records. Within 24 hours of receiving the patient, with signed informed consent, an interview
was conducted and the best possible medication history was taken. The Lexi-Comp®Online
database was used to identify potential clinically significant drug interactions.
Results: 58 patients with a median age of 75 years were included in the study, of which
53,4 % were men. A total of 623 drugs were prescribed to the patients, which is 10,7 drugs per
patient. A total of 41,4 % of patients had asymptomatic hyperuricemia that was treated with
allopurinol. Less than half of the patients (48,3 %) had serum uric acid concentration within the
reference values. A total of 95 potentially clinically significant interactions of grade D and C
of allopurinol with other prescribed drugs were identified, which means 1,8 potentially
clinically significant interactions of allopurinol per patient. The share of drug interactions of
significance level D was 12,6 %, and of significance level C 87,4 %. In patients who were
prescribed febuxostat in pharmacotherapy, no potential clinically significant drug interactions
were identified.
Conclusion: The introduction of pharmacotherapy to lower urate in patients with
asymptomatic hyperuricemia increases the risk of side effects and clinically significant drug
interactions, which may endanger patient safety. More than half of the patients receiving uratelowering pharmacotherapy did not have a serum uric acid concentration within reference
values. The results indicate the importance of optimizing pharmacotherapy in patients with
hyperuricemia. |