An updated systematic review and meta-analysis of randomised controlled trials on the effects of urate-lowering therapy initiation during a gout flare
Authors' conclusion
There appears to be no evidence for harm or for benefit to initiating ULT during a gout flare.
Study context
- Population
- Adults ≥18 years with a gout flare in randomised controlled trials (RCTs) published in English; participants with renal impairment excluded from most studies; few with tophaceous gout (n = 62, 13.9 %)
- Participants
- 445 adults6 RCTs
- Comparison
- Early initiation of urate-lowering therapy (ULT) during a gout flare vs placebo or delayed initiation of ULT
- Early ULTn = 226
- Placebo or delayed ULTn = 219reference
- Outcome
- Patient-rated pain score at baseline, days 3-4, days 7-8, day 10 and days 14-15
Methodological detailsPRISMA methodology, revised Cochrane Risk of Bias tool 2.0, Risk of bias: three studies high, one some concerns, two low
- PRISMA methodology
- Revised Cochrane Risk of Bias tool 2.0
- Risk of bias: three studies high, one some concerns, two low
Pooled result
As reported in the abstract
- No differences in patient-rated pain scores at any time point
- p ≥ 0.42
Further pooled results
Time to resolution of gout flare
- No significant difference; SMD
- 0.77 days (95% CI −0.26 to 1.79; p = 0.14)
Risk of recurrent gout flare in the subsequent 28 to 30 days
- No significant difference; RR
- 1.06 (95% CI 0.59 to 1.92; p = 0.84)
Original publication
An updated systematic review and meta-analysis of randomised controlled trials on the effects of urate-lowering therapy initiation during a gout flare. Semin Arthritis Rheum. Published 7 January 2024. doi:10.
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