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

Wirksamkeit des Beginns einer harnsäuresenkenden Therapie während eines akuten Gichtanfalls: eine Metaanalyse

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Abstract

Objective

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

Methods

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.

Results

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.

Conclusion

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.

Zusammenfassung

Ziel der Arbeit

Ziel der vorliegenden Arbeit war es, die Wirksamkeit des Beginns einer harnsäuresenkenden Therapie während eines akuten Gichtanfalls zu untersuchen.

Methoden

Dazu wurde eine Literatursuche (vom Beginn bis Februar 2023) in den Datenbanken MEDLINE, EMBASE und dem Cochrane Central Register of Controlled Trials durchgeführt. Es wurde eine umfassende Übersicht und Metaanalyse randomisierter kontrollierter Studien (RCT) zur Wirksamkeit einer harnsäuresenkenden Therapie während eines akuten Gichtanfalls erstellt.

Ergebnisse

Die vorliegende Übersichtsarbeit umfasst 6 RCT mit 479 Patienten (225 Versuchsteilnehmer und 254 Kontrollen). Bei der Versuchsgruppe war die Zahl der Tage bis zur Besserung größer als bei der Kontrollgruppe. Zwischen den Gruppen bestand kein signifikanter Unterschied hinsichtlich der Werte in der visuellen Analogskala am Tag 10. Die Blutsenkungsgeschwindigkeit und der Wert für C‑reaktives Protein unterschieden sich nicht wesentlich zwischen den Gruppen an den Tagen 7–14. Beide Gruppen wiesen nach 30 Tagen ähnliche Raten an Rezidiven eines Gichtanfalls auf. Auch bestand kein signifikanter Unterschied zwischen den Gruppen hinsichtlich der Abbrecherquote.

Schlussfolgerung

Der Beginn einer harnsäuresenkenden Therapie während eines Gichtanfalls scheint nicht zur einer Zunahme der Anfallsdauer oder der Schmerzen zu führen. Trotz dieser Erkenntnisse sind weitere Studien mit größeren Stichproben erforderlich, um diese Schlussfolgerungen zu bestätigen.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, 02841, Seongbuk-gu, Seoul, Korea (Republic of)

    Young Ho Lee MD, PhD & Gwan Gyu Song

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  1. Young Ho Lee MD, PhD
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  2. Gwan Gyu Song
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Correspondence to Young Ho Lee MD, PhD.

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Conflict of interest

Y.H. Lee and G.G. Song declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Ulf Müller-Ladner, Bad Nauheim

Uwe Lange, Bad Nauheim

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Lee, Y.H., Song, G.G. Efficacy of initiating urate-lowering therapy during an acute gout episode: a meta-analysis. Z Rheumatol 82, 763–769 (2023). https://doi.org/10.1007/s00393-023-01366-x

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