Oral prednisolone versus non-steroidal anti-inflammatory drugs in the treatment of acute gout: a meta-analysis of randomized controlled trials
- 75 Downloads
To evaluate the efficacy and safety of oral prednisolone in the treatment of acute gout compared with non-steroidal anti-inflammatory drugs (NSAIDs).
A comprehensive search of databases in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors.
Three double-blind, randomized, controlled trials were included in the final analysis, with a total of 584 patients. Regarding the efficacy, oral prednisolone (30–35 mg/day) was comparable with NSAIDs (naproxen at 500 mg/day or indomethacin at 50–100 mg/day) on the pain relief scale, both in activity (difference in means 0.259, 95% CI − 1.532 to 2.050, P = 0.777) and at rest (difference in means − 0.502, 95% CI − 4.961 to 3.956, P = 0.825) during the first 2–6 h. During the following 4 to 6 days, prednisolone acted with comparable efficacy either in activity (difference in means − 0.552, 95% CI − 1.364 to 0.260, P = 0.183) or at rest (difference in means − 0.164, 95% CI − 0.463 to 0.134, P = 0.281). Regarding safety, prednisolone did not increase the total adverse events (AEs) (risk ratios [RR] 0.765, 95% CI 0.473 to 1.238, P = 0.275) and reduced the withdrawal rate because of the AEs (RR 0.127, 95% CI 0.021–0.763, P = 0.024). Prednisolone decreased the risks of several AEs (including indigestion: RR 0.544, 95% CI 0.311–0.952, P = 0.033; nausea: RR 0.296, 95% CI 0.136–0.647, P = 0.002; and vomiting: RR 0.155, 95% CI 0.033–0.722, P = 0.018) but increased the risk of skin rashes (RR 4.049, 95% CI 1.241–13.158, P = 0.021).
Oral prednisolone may be of similar efficacy and a slightly safer strategy for treatment of active, acute gout compared with NSAIDs. Further clinical studies are still warranted to investigate its long-term efficacy and safety.
KeywordsAcute gout Prednisolone NSAIDs Pain Meta-analysis
American College of Rheumatology
China Food and Drug Administration
Chinese Clinical Trial Register
European League against Rheumatism
Non-steroidal anti-inflammatory drugs
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
This work was funded by the Zhejiang Provincial Natural Science Foundation of China (LY16H280005 and LQ16H270004), and partly by the National Natural Science Foundation of China (81673623 and 81603088). Z.Xu. and C.W. designed study; J.Y., H.L., and Z. Xu performed research and analyzed data; Z.J. and Z. Xie Contributed suggestion & discussion; Z. Xu wrote the paper.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- Chinese Rheumatology Association (2016) 2016 Chinese guidelines to diagnosis and treatment of gout [in Chinese]. Chin J Intern Med 55:892–899Google Scholar
- Cui M, Liu Z (2016) The clinical effect of different analgesic anti-inflammatory solution in the treatment of acute gouty arthritis [in Chinese]. Chin J of Clinical Rational Drug Use 9:30–35Google Scholar
- Janssens HJ, Lucassen PL, Van de Laar FA, Janssen M, Van de Lisdonk EH (2008a) Systemic corticosteroids for acute gout. The Cochrane database of systematic reviews: CD005521Google Scholar
- Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, Liote F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T (2017) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 76:29–42CrossRefPubMedGoogle Scholar
- van Walsem A, Pandhi S, Nixon RM, Guyot P, Karabis A, Moore RA (2015) Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis. Arthritis Res Ther 17:66CrossRefPubMedPubMedCentralGoogle Scholar
- Wechalekar MD, Vinik O, Moi JH, Sivera F, van Echteld IA, van Durme C, Falzon L, Bombardier C, Carmona L, Aletaha D, Landewe RB, van der Heijde DM, Buchbinder R (2014) The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors. J Rheumatol Supplement 92:15–25Google Scholar