A treatment review for acute gout attacks and management has found strong evidence that colchicine, NSAIDs, and corticosteroids are effective in relieving pain in acute gout patients.
Researchers from the University of California, Los Angeles, extracted studies of 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, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids reduce pain in patients with acute gout.
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 timeframe 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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