AB0921 COMPARISON OF EFFICACY AND SAFETY OF DIFFERENT ANTI-INFLAMMATORY DRUGS AT INITIATION OF URATE-LOWERING THERAPY IN PATIENTS WITH GOUT (PRELIMINARY DATA)
Authors: M. Chikina, M. Elisеev
Journal: Annals of the Rheumatic Diseases (2020)

Background: NSAIDs, colchicine and glucocorticoids are used for prevention of acute arthritis in gout patients, yet there is little data on their comparative efficacy. Objectives: Comparison of efficacy and safety of different anti-inflammatory drugs used for prevention of acute arthritis at initiation of urate-lowering therapy in gout patients. Methods: This monocentric prospective study included 79 gout patients (75 (94.9%) male and 4 (5.1%) female patients) with the mean age of 51.3±10.9 years old. The inclusion criteria were the following: established gout (ACR/EULAR 2015 criteria), aged 18-80, serum uric acid level &gt;360µmol/L, absence of urate-lowering therapy at baseline and at least one gout flare within past three months. The exclusion criteria were: absolute contraindications to all of the study drugs, GFR &lt;30ml/min/1.73m2. All of the patients were prescribed urate-lowering therapy (allopurinol or febuxostat), the dose was titrated until the target serum uric-acid level (&lt;360µmol/L) was achieved. Simultaneously, preventive anti-inflammatory therapy was initiated and the drug for each patient was chosen individually: colchicine 0.5mg/day or any NSAID in minimal anti-inflammatory dose or prednisolone 7.5mg/day. The analysis of the data included 3-month comparative evaluation of the efficacy of the preventive therapy against the following parameters: frequency of gout flare and duration thereof, VAS pain intensity of flare. The laboratory tests included serum creatinine level, uric acid level, AST, ALT, creatine phosphokinase, glucose; clinical blood test before, two weeks and three months after the initiation of the therapy. Results: NSAIDs were received by 14 (17.7%) patients, colchicine by 56 (70.9%) and glucocorticoids by 9 (11.4%) patients. There were no differences initially in age, GFR or lab test values. Three months later, the gout flares frequency median lowered to 1 [0;2] flare (p&lt;0.01). The frequency of gout flares did not depend on the chosen drug and was 1 [0;1] for NSAIDs, 1 [0;2] for colchicine and 1 [1;2] for glucocorticoids. 40 (50.6%) patients out of 79 did not have a single flare. The patients who received NSAIDs (57.1%) and colchicine (42.9%) experienced no gout flares more often than those who received glucocorticoids (37.5%), but the differences were not significant. However, the VAS pain intensity of gout flares in the patients who received NSAIDs (30.7±12.9mm) was lower than in those who received colchicine (42.1±12.3mm) and glucocorticoids (42.2±8.4mm) (p&lt;0.05 for both). The duration of gout flares on different drugs was not significantly different and was on average 3 [1.5;4] days for the patients on NSAIDs, 5 [3;7] days for those on colchicine and 5 [4;6] days for the patients who received glucocorticoids. The NSAID therapy was discontinued in two cases, in which the serum transaminase levels (AST, ALT) more than doubled; the colchicine therapy - because of development of diarrhea in two patients and of myopathy in one. Conclusion: Efficacy of and tolerance to a three-month course of preventive therapy with NSAIDs and glucocorticoids in gout patients are comparable to that with colchicine. In case of development of gouty arthritis, preventive use of NSAIDs is characterized by lower pain intensity than as against colchicine or glucocorticoids. Disclosure of Interests: Maria Chikina: None declared, Maxim Elisеev Speakers bureau: Novartis, Menarini Group, Alium