Comparative Cardiovascular Safety of Nonsteroidal Anti‐Inflammatory Drug Versus Colchicine Use When Initiating Urate‐Lowering Therapy Among Patients With Gout: Target Trial Emulations
Authors' conclusion
In these target trial emulations of patients with gout starting allopurinol, NSAID prophylaxis was associated with a higher risk of MACE than colchicine or no prophylaxis
Study context
- Population
- Adults with gout starting allopurinol (83.5% male, mean age 60.9 years)propensity score-matched
- Participants
- 18,120 adults
- Comparison
- Nonsteroidal anti-inflammatory drugs (NSAIDs) vs colchicine for gout flare prophylaxis when starting allopurinol
- Outcome
- Major adverse cardiovascular events (MACE):
- MI
- Stroke
- Cardiovascular death
Methodological detailsnew-user comparative effectiveness study, sequential, propensity score-matched, inverse probability of treatment weighting (IPTW) sensitivity analysis
- New-user comparative effectiveness study
- Sequential
- Propensity score-matched
- IPTW sensitivity analysis
Main finding
As reported in the abstract
MACE
Each group vs colchicineRate difference, per 1,000 person-years (95% CI)
NSAIDs
38.8(15.4–62.2)
Each group vs colchicineHazard ratio (95% CI)
NSAIDs
1.56(1.11–2.17)
Further findings
| Outcome | Rate difference (per 1,000 person-years) (95% CI) | |
|---|---|---|
| Cardiovascular deathNSAIDsvs Colchicine | 10.9 (0.7–21.1) | |
| −100102030Difference, per 1,000 person-years (linear scale) |
| Outcome | HR (95% CI) | |
|---|---|---|
| Cardiovascular deathNSAIDsvs Colchicine | 2.50 (1.14–5.26) | |
| MACE,vs no prophylaxis | 1.50 (1.17–1.91) | |
| MI,vs no prophylaxis | 1.93 (1.35–2.75) | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Comparative Cardiovascular Safety of Nonsteroidal Anti‐Inflammatory Drug Versus Colchicine Use When Initiating Urate‐Lowering Therapy Among Patients With Gout: Target Trial Emulations. Arthritis Rheumatol. Published 29 July 2025. doi:10.
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