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Comparative Risk of Gout Flares When Initiating or Escalating Various Urate-Lowering Therapy: A Systematic Review
Dorsa Maher1, Emily Reeve2, Ashley Hopkins3
1University of South Australia and Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.
Arthritis Care & Research
|February 2, 2024
Summary
Gout flare risk varies with urate-lowering therapies (ULTs). Colchicine and rilonacept reduce flare incidence when used with ULTs, but more research is needed on prophylaxis harms and duration.
Area of Science:
- Rheumatology
- Pharmacology
- Clinical Research
Background:
- Gout flares are common upon initiating or escalating urate-lowering therapies (ULTs).
- Understanding comparative flare risk and the role of flare prophylaxis is crucial for effective gout management.
Approach:
- A systematic review and random effects network meta-analysis of 27 trials (3,775 records) was conducted.
- Comparative risk ratios (RRs) for flares were calculated for various urate-lowering therapies (ULTs) with and without flare prophylaxis.
- Bias was assessed using the revised Cochrane risk-of-bias tool.
Key Points:
- Flare risk varied significantly with different urate-lowering therapies (ULTs) and dosing strategies.
- Flare prophylaxis with colchicine and rilonacept demonstrated a reduced incidence of gout flares compared to ULT alone.
- Limited data exist on the adverse events and optimal duration of flare prophylaxis.
Conclusions:
- The choice of urate-lowering therapy (ULT) and dosing impacts gout flare risk.
- Colchicine and rilonacept are effective prophylactic agents against flares during ULT initiation.
- Further research is necessary to fully understand the safety profile and optimal use of flare prophylaxis.
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