The Impact of Starting Urate-Lowering Therapy (ULT) During A Gout Flare on The Ongoing Episode: A Systematic Review of Randomized Controlled Trials

https://doi.org/10.22146/actainterna.101289

Komang Satvika Yogiswara(1), Putu Raka Widhiarta(2), Ketut Shri Satya Wiwekananda(3), Ayu Paramaiswari(4), Dedy Nurwachid Achadiono(5), Gede Kambayana(6), Nyoman Kertia(7*)

(1) Faculty of Medicine, Udayana University
(2) Faculty of Medicine, Udayana University
(3) Faculty of Medicine, Gadjah Mada University
(4) Faculty of Medicine, Gadjah Mada University
(5) Faculty of Medicine, Gadjah Mada University
(6) Faculty of Medicine, Udayana University
(7) Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


Background. Gout is a prevalent form of arthritis caused by the accumulation of monosodium urate (MSU) crystals. Urate-lowering therapy (ULT) may be started once an acute flare has subsided to prevent the present episode from lasting longer. Nevertheless, ULT may be commenced during an acute flare-up in order to decrease the frequency of outpatient appointments and enhance patient adherence. The objective of this study was to conduct whether the commencement of urate-lowering therapy (ULT) during an acute gout flare is effective.

Method. We performed a systematic review of articles published in MEDLINE, PubMed, Cochrane library, and EMBASE databases from 2018 to 2023. The search was limited to articles published in English, and RCTs in patients older than 18 years.

Results and Discussions. Among 242 recorded studies, only four with 323 patients were eligible for this research. The treatment with Allopurinol began with a daily dose    of 100 mg for the initial 14 days, followed by an increase to a daily dose of 200 mg for     the subsequent 14 days. The reported time to resolution was 15.4 days for the group receiving allopurinol and 13.4 days for the group receiving the placebo. According to this review, the start of ULT (uric acid-lowering therapy) should be determined by sufficient anti-inflammatory measures. Commencing ULT during a gout flare has no impact on the intensity, duration, or likelihood of recurrence of the flare within the following 28 to 30 days.

Conclusions. This study demonstrated that the commencement of urate-lowering therapy (ULT) during an acute gout flare did not result in a longer duration of the flare. Nevertheless, it is necessary to conduct a clinical  studies with a bigger sample size in order to validate this review.

Keywords


Gout flare, Urate-Lowing therapy, Initiation therapy, effectiveness, safety



References

Uhlig T, Karoliussen LF, Sexton J, Kvien TK, Haavardsholm EA, Perez-Ruiz F, et al. One-and 2-year flare rates after treat-to-target and tight-control therapy of gout: results from the NOR-Gout study. Arthritis Res Ther. 2022;24(1):88.

Pillinger MH, Mandell BF. Therapeutic approaches in the treatment of gout. In: Seminars in Arthritis and Rheumatism. Elsevier; 2020. p. S24–30.

Terkeltaub R. Emerging urate-lowering drugs and pharmacologic treatment strategies for gout: a narrative review. Drugs. 2023;83(16):1501–21.

Pang L, Xue X, He Y, Wang C, Han L, Li M, et al. The effect of decrease in serum urate for the risk of gout flares during urate-lowering therapy initiation among Chinese male gout patients: a prospective cohort study. J Inflamm Res. 2023;3937–47.

Aung T, Myung G, FitzGerald JD. Treatment approaches and adherence to urate-lowering therapy for patients with gout. Patient Prefer Adherence. 2017;795–800.

Graham GG, Stocker SL, Kannangara DRW, Day RO. Predicting response or non-response to urate-lowering therapy in patients with gout. Curr Rheumatol Rep. 2018;20:1–7.

Maher D, Reeve E, Hopkins A, Tan JM, Tantiongco M, Ailabouni N, et al. Comparative risk of gout flares when initiating or escalating various urate-lowering therapy: a systematic review with network meta-analysis. Arthritis Care Res (Hoboken). 2024;

Choi HK, Zhang Y, Dalbeth N. When underlying biology threatens the randomization principle—initial gout flares of urate-lowering therapy. Nat Rev Rheumatol. 2022;18(9):543–9.

Sun R, Lu J, Li H, Cheng X, Xin Y, Li C. Evaluation of febuxostat initiation during an acute gout attack: a prospective, randomized clinical trial. Joint Bone Spine. 2020;87(5):461–6.

Jia E, Zhang Y, Ma W, Li B, Geng H, Zhong L, et al. Initiation of febuxostat for acute gout flare does not prolong the current episode: a randomized clinical trial. Rheumatology. 2021;60(9):4199–204.

Satpanich P, Pongsittisak W, Manavathongchai S. Early versus late allopurinol initiation in acute gout flare (ELAG): a randomized controlled trial. Clin Rheumatol. 2022;41(1):213–21.

Yang DH, Chen HC, Wei JCC. Early urate-lowering therapy in gouty arthritis with acute flares: a double-blind placebo controlled clinical trial. Eur J Med Res. 2023;28(1):10.

Perez-Ruiz F, Dalbeth N. Combination urate-lowering therapy in the treatment of gout: What is the evidence? In: Seminars in arthritis and rheumatism. Elsevier; 2019. p. 658–68.

Dalbeth N, Doyle AJ, Billington K, Gamble GD, Tan P, Latto K, et al. Intensive serum urate lowering with oral urate‐lowering therapy for erosive gout: a randomized double‐blind controlled trial. Arthritis & Rheumatology. 2022;74(6):1059–69.

Latourte A, Bardin T, Richette P. Prophylaxis for acute gout flares after initiation of urate-lowering therapy. Rheumatology. 2014;53(11):1920–6.



DOI: https://doi.org/10.22146/actainterna.101289

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