Comparative Risk of Gout Flares When Initiating or Escalating Various Urate‐Lowering Therapy: A Systematic Review With Network Meta‐Analysis
Authors' 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.
Study context
- Population
- Trials of adults with gout initiating or escalating ULT; databases searched from inception to November 202127 trials (29 publications)
- Comparison
- Initiation or escalation of different urate-lowering therapies (ULTs), with and without concomitant flare prophylaxis
- Outcome
- Gout flare risk
Methodological detailsrandom effects network meta-analyses, revised Cochrane risk-of-bias tool, High risk of bias in 71.4% of studies for flares and 63.4% for adverse events, mainly from missing outcome data and selective reporting
- Random effects network meta-analyses
- Revised Cochrane risk-of-bias tool
- High risk of bias in 71.4% of studies for flares and 63.4% for adverse events, mainly from missing outcome data and selective reporting
Pooled result
As reported in the abstract
Gout flares vs placebo plus prophylaxis (range across ULTs)
Each group vs placebo plus prophylaxisRelative risk (95% CI)
Febuxostat 40 mg plus prophylaxislowest RR of the range
1.08(0.87–1.33)
Febuxostat 80 mg plus lesinurad 400 mg plus prophylaxishighest RR of the range
2.65(1.58–4.45)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Gout flares with vs without flare prophylaxisULT plus rilonacept 160 mgvs ULT alone | 0.35 (0.25–0.50) | |
| Gout flares with vs without flare prophylaxisULT plus rilonacept 80 mgvs ULT alone | 0.43 (0.31–0.60) | |
| Gout flares with vs without flare prophylaxisULT plus colchicinevs ULT alone | 0.50 (0.35–0.72) | |
| 0.20.5125Relative risk (log scale) |
Other flare prophylaxis, prophylaxis harms and optimal duration
- Limited evidence
Original publication
Comparative Risk of Gout Flares When Initiating or Escalating Various Urate‐Lowering Therapy: A Systematic Review With Network Meta‐Analysis. Arthritis Care Res (Hoboken). Published 14 March 2024. doi:10.
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