Gout flare severity, recurrence risk not impacted by timing of urate lowering therapy
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Key takeaways:
- Delaying initiation of ULT during gout flares had no impact on flare severity, duration or recurrence risk.
- Patient preference and other individualized factors can determine when to start ULT.
Starting urate lowering therapy during a gout flare does not impact the flare’s severity, duration or risk for recurrence over the following month, according to a systematic review and meta-analysis.
“Despite being a well-established therapy for gout, the timing of ULT initiation in relation to a gout flare remains debated,” Vicky Tai, MBChB, of the University of Auckland, in New Zealand, and colleagues wrote in Seminars in Arthritis and Rheumatism. “Traditionally, for people with indications for UL, ULT initiation has been delayed for 1 to 2 weeks after resolution of a gout flare due to concerns that sudden changes in serum urate levels will result in remodeling of microscopic tophi leading to exacerbation or prolongation of the flare.”
To assess the impact of starting ULT during a gout flare, Tai and colleagues conducted a systematic review and meta-analysis of six randomized controlled trials. The trials included a total of 455 participants, 226 of whom were randomly assigned to early initiation of ULT while 219 received placebo or delayed ULT treatment. Assessed treatments were allopurinol in three studies, febuxostat in two studies, and probenecid in one.
The meta-analysis revealed no differences in patient-reported pain scores compared with placebo across 14 to 15 days of treatment (P .42), according to the researchers. Among the three studies that assessed duration of the gout flare, the meta-analysis also found no differences in time to resolution (standardized mean difference [SMD], 0.77 days; 95% CI, –0.26 to 1.79).
There were also no differences in the risk for flare recurrence over the following 28 to 38 days (RR = 1.06; 95% CI, 0.59-1.92) in a meta-analysis of four of the studies. Adverse events, reported in five of the studies, were similar across all treatment groups.
“Our updated systematic review and meta-analysis of RCTs suggests that initiation of ULT during a gout flare does not affect the severity of the flare, nor the duration of the flare or risk of recurrence in the subsequent 28 to 30 days,” Tai and colleagues wrote. “However, important caveats include the small sample size and the low to moderate quality of included studies. Additionally, our findings may not be applicable to patients with tophaceous gout or comorbid renal disease. Therefore, an individualized approach to patient management is recommended.”
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