A treatment review for acute gout attacks and management has found strong evidence that colchicine, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids are effective in relieving pain in patients with acute gout.

Researchers from the University of California, Los Angeles, extracted studies from the US Food and Drug Administration (FDA) approved drugs, those commonly prescribed by primary care physicians, randomized trials for effectiveness, and trials and observational studies on adverse events. The studies were extracted from electronic databases between January 2010 to March 2016.

Twenty-eight trials – only three of which were placebo-controlled – were deemed to contain high-strength evidence to show that colchicine, NSAIDs, and corticosteroids reduce pain in patients with acute gout. 


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High Yield Data Summary

  • Meta-analysis finds high-strength evidence for the use of colchicine, NSAIDs, and corticosteroids for the treatment of acute gout attacks and high-strength evidence supporting the use of urate-lowering therapy with allopurinol or febuxostat to decrease serum urate levels

High-strength evidence also suggested that prophylaxis with daily colchicine or NSAIDs reduces the risk for acute gout attacks by at least half in patients starting urate-lowering therapy. 

The researchers found that the duration of prophylaxis should be longer than 8 weeks, however the evidence for this time frame was considered to be of moderate-strength.

For dosage efficacy, moderate-strength evidence suggest that low-dose colchicine is as effective as a high-dose and can cause fewer gastrointestinal adverse events. 

Urate-lowering therapies, allopurinol or febuxostat, were found to reduce the long-term risk for acute gout attacks after 1 year, however this finding was deemed to be of moderate-strength.

The authors acknowledged that their study had limitations, including no placebo-controlled studies of hyperuricemia management lasted longer than 6 months.

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Reference

Shekelle PG, Newberry SJ, Fitzgerald JD, et al. Management of gout: A systematic review in support of an American College of Physicians clinical practice guideline. Ann Intern Med. 2016 Nov 1. doi: 10.7326/M16-0461 [Epub ahead of print]

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This article originally appeared on MPR