Brian,
Doesn't this give a NNT for one year to prevent one recurrence of 7? Seems like a good enough NNT to at least present to the patient for his consideration.
Jim
Optimized biomedical information in the nick of time.
James M. Walker, MD
Assistant Professor, Medicine
Senior Clinical Information Architect
Penn State Geisinger Health System
Penn State College of Medicine
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>>> <[log in to unmask]> 03/28 7:19 AM >>>
In a message dated 3/28/00 1:20:35 AM Pacific Standard Time,
[log in to unmask] writes:
> Yesterday a 35 year old man came to see me following investigations for
> renal calculus. The calculus was calcium oxalate, but he was found on
> two occasions to have blood uric acid above the normal range. The
> consultant urologist suggested that I prescribe allopurinol.
Hello Toby,
I believe that the urologist was familiar with this study:
.................
Ettinger B, Tang A, Citron JT, Livermore B, Williams T. Randomized trial of
allopurinol in the prevention of calcium oxalate calculi. N Engl J Med 1986
Nov 27;315(22):1386-9.
In a double-blind study, we examined the efficacy of allopurinol in the
prevention of recurrent calcium oxalate calculi of the kidney. Sixty patients
with hyperuricosuria and normocalciuria who had a history of calculi were
randomly assigned to receive either allopurinol (100 mg three times daily) or
a placebo. After the study, the placebo group had 63.4 percent fewer calculi
(P less than 0.001), whereas the allopurinol group had 81.2 percent fewer
calculi (P less than 0.001). During the study period, the mean rate of
calculous events was 0.26 per patient per year in the placebo group and 0.12
in the allopurinol group. When the treatment groups were compared by
actuarial analysis, the allopurinol group was found to have a significantly
longer time before recurrence of calculi (P less than 0.02). We conclude that
allopurinol is effective in the prevention of calcium oxalate stones in
patients with hyperuricosuria. The large reduction in the frequency of
calculi in the placebo group underscores the positive treatment bias that
regularly occurs in trials of prophylaxis against renal calculi when
historical controls are used.
.........................
This was a pretty small trial (only 60 patients) and I personally have not
found it persuasive enough to alter practice. But there it is.
Cheers and Best Wishes,
Brian
....................................
Brian Budenholzer, MD
Director, Clinical Enhancement & Development
AC 18
Group Health Cooperative; Network Services Division
PO Box 204
Spokane, WA 99210-0204
USA
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509/ 838-9100 X 7393
fax: 509/ 458-0368
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