Comparative Risk of Gout Flares When Initiating or Escalating Various Urate‐Lowering Therapy: A Systematic Review With Network Meta‐Analysis
Objective We systematically examined comparative gout flare risk after initiation or escalation of different urate‐lowering therapies (ULTs), comparative flare risk with and without concomitant flare prophylaxis, adverse event rates associated with flare prophylaxis, and optimal duration of flare pr...
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Published in | Arthritis care & research (2010) Vol. 76; no. 6; pp. 871 - 881 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Boston, USA
Wiley Periodicals, Inc
01.06.2024
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Objective
We systematically examined comparative gout flare risk after initiation or escalation of different urate‐lowering therapies (ULTs), comparative flare risk with and without concomitant flare prophylaxis, adverse event rates associated with flare prophylaxis, and optimal duration of flare prophylaxis.
Methods
We searched the Medline, Embase, Web of Science, and Cochrane databases and clinical trial registries from inception to November 2021 for trials investigating adults with gout initiating or escalating ULT. We performed random effects network meta‐analyses and calculated risk ratios (RRs) between treatments. Bias was assessed using the revised Cochrane risk‐of‐bias tool.
Results
We identified 3,775 records, of which 29 publications (27 trials) were included. When compared to placebo plus prophylaxis, the RR of flares ranged from 1.08 (95% confidence interval [CI] 0.87–1.33) for febuxostat 40 mg plus prophylaxis to RR 2.65 [95% CI 1.58–4.45] for febuxostat 80 mg plus lesinurad 400 mg plus prophylaxis. Compared to ULT alone, the RR of flares was lower for ULT plus rilonacept 160 mg (RR 0.35 [95% CI 0.25–0.50]), ULT plus rilonacept 80 mg (RR 0.43 [95% CI 0.31–0.60]) and ULT plus colchicine (RR 0.50 [95% CI 0.35–0.72]). There was limited evidence for other flare prophylaxis and on prophylaxis harms and optimal duration. Primarily because of missing outcome data and bias in the selection of reported results, 71.4% and 63.4% of studies were assessed as high risk of bias for flares and adverse events, respectively.
Conclusion
The RR of flares when introducing ULT varies depending on ULT drug and dosing strategies. There were limited data on ULT escalation. Flare prophylaxis with colchicine and rilonacept reduces flare incidence. More research is required on the harms and optimal duration of prophylaxis. |
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Bibliography: | th Additional supplementary information cited in this article can be found online in the Supporting Information section Author disclosures are available at https://onlinelibrary.wiley.com/doi/10.1002/acr.25309 Annual Research Symposium, the Australasian Pharmaceutical Science Association – Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (APSA‐ASCEPT) 2022 Joint Conference, and the Australian Rheumatology Association (ARA) 2023 Annual Scientific Meeting. Preliminary findings of this research have been presented as an oral presentation at the Gout, Hyperuricemia and Crystal‐Associated Disease Network (G‐CAN) 2022 8 Supported by an Australian Government Research Training Program Scholarship. Drs Reeve and Hopkins’ work was supported by the National Health and Medical Research Council of Australia (Investigator grants GNT1195460 and GNT2008119, respectively). http://onlinelibrary.wiley.com/doi/10.1002/acr.25309 . ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 |
ISSN: | 2151-464X 2151-4658 |
DOI: | 10.1002/acr.25309 |