Objective To assess the risk of hypersensitivity reactions (HSRs) with allopurinol and febuxostat in a population-based study. Methods We used the 5% Medicare beneficiary sample (≥65 years) from 2006 to 2012 to identify people with a newly filled prescription for allopurinol, febuxostat or colchicine. We used multivariable-adjusted Cox regression analyses to compare the hazard ratio (HR) of incident HSRs with allopurinol or febuxostat use versus colchicine use; separate analyses were done in people exposed to allopurinol. Propensity-matched analyses (5:1) compared hazards with allopurinol versus febuxostat. Results Crude incidence rates of HSRs were as follows: allopurinol, 23.7; febuxostat, 30.7; and colchicine, 25.6 per 1000 person-years. Compared with colchicine, allopurinol, febuxostat and febuxostat+colchicine were associated with significantly higher HRs of HSRs, 1.32 (95% CI: 1.10 to 1.60) and 1.54 (95% CI: 1.12 to 2.12) and 2.17 (95% CI: 1.18 to 3.99), respectively. In propensity-matched analyses, febuxostat did not significantly differ from allopurinol; HR for HSRs was 1.25 (95% CI: 0.93 to 1.67). Compared with allopurinol start dose <200 mg/day, allopurinol start dose ≥300 mg/day, diabetes and female sex were associated with significantly higher hazard of HSRs, 1.27 (95% CI: 1.12 to 1.44), 1.21 (95% CI: 1.00 to 1.45) and 1.32 (95% CI: 1.17 to 1.48), respectively. The majority (69%) of HSRs occurred in the outpatient setting. Conclusions Compared with colchicine, allopurinol and febuxostat similarly increased the risk of HSRs. Allopurinol and febuxostat did not differ from each other. In allopurinol users, starting dose, female sex and diabetes increased this risk, findings that need further study.

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别嘌醇和非布司他的超敏反应：一项使用医疗保险索赔数据的研究

目的在一项基于人群的研究中评估别嘌醇和非布索坦引起过敏反应 (HSR) 的风险。方法 我们使用 2006 年至 2012 年 5% 的医疗保险受益人样本（≥65 岁）来识别新开出别嘌醇、非布索坦或秋水仙碱处方的人。我们使用多变量调整的 Cox 回归分析来比较使用别嘌醇或非布索坦与使用秋水仙碱的事件 HSR 的风险比 (HR)；在暴露于别嘌醇的人群中进行了单独的分析。倾向匹配分析 (5:1) 比较了别嘌醇与非布索坦的危害。结果 HSR的粗发病率如下：别嘌醇，23.7；非布司他，30.7；和秋水仙碱，25.6/1000 人年。与秋水仙碱、别嘌醇相比，非布司他和非布司他+秋水仙碱与 HSR 显着较高的 HR 相关，分别为 1.32（95% CI：1.10 至 1.60）和 1.54（95% CI：1.12 至 2.12）和 2.17（95% CI：1.18 至 3.99）。在倾向匹配分析中，非布索坦与别嘌醇没有显着差异。HSR 的 HR 为 1.25（95% CI：0.93 至 1.67）。与别嘌醇起始剂量<200 mg/天、别嘌醇起始剂量≥300 mg/天相比，糖尿病和女性与HSRs的风险显着增加相关，1.27（95% CI：1.12至1.44），1.21（95% CI： 1.00 至 1.45）和 1.32（95% CI：1.17 至 1.48）。大多数（69%）的 HSR 发生在门诊。结论 与秋水仙碱相比，别嘌醇和非布索坦同样会增加 HSR 的风险。别嘌醇和非布司他没有区别。在别嘌醇使用者中，