Efficacy of initiating urate-lowering therapy during an acute gout episode: a meta-analysis

This study aimed to evaluate the effectiveness of initiating urate-lowering therapy (ULT) during acute gout episodes.

We performed a literature search using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (from inception to February 2023). We conducted a comprehensive review and meta-analysis of randomized controlled trials (RCTs) that examined the efficacy of ULT in individuals with acute gout flares.

This review included six RCTs with 479 patients (225 experimental participants and 254 controls). The experimental group had longer days to resolution than did the control group. There was no significant difference in the pain visual analogue scale score between the groups by day 10. Erythrocyte sedimentation rate and C‑reactive protein level did not significantly differ between the groups by days 7 to 14. Both groups had similar rates of recurrent gout attacks by 30 days. There was no significant between-group difference in the dropout rate.

Initiating ULT therapy during a gout attack does not appear to increase the duration of the flare or aggravate pain. Despite these findings, further studies with larger sample sizes are necessary to support these conclusions.