Takeaway

  • Low-dose colchicine is no better than naproxen for acute gout flares but costs more and has more side effects, according to the CONTACT randomized pragmatic trial.





Why this matters

  • Study authors support naproxen as the first-line treatment for acute gout flares in the absence of contraindications.

Study design

  • An open-label randomized trial in 100 primary pragmatic practices (n = 349) of naproxen (750 mg, then a 250 mg every 8 hours for 7 days) or colchicine (500 μ g 3 times daily for 4 days).
  • Primary outcome: change from baseline in pain (numeric rating scale 0-10, with 10 being highest pain) over days 1-7.
  • Funding: National Institute for Health Research.

Key results

  • No difference between groups for colchicine vs naproxen:
    • Over days 1-7 vs baseline:
      • Adjusted mean difference, −0.18 (P = .32).
    • At 4 weeks vs baseline:
      • Adjusted mean difference, −0.09 (P = .68).
  • Higher rate of “any side effects” with colchicine vs naproxen:
    • 69.2% vs 60.7%. 
      • Imputed OR, 1.60 (P = .038).
  • These side effects included:
    • Headache: 20.5% vs. 10.7%.
      • Imputed OR, 1.92 (P = .039).
    • Diarrhea: 45.9% vs. 20.0%.
      • Imputed OR, 3.31 (P <.001). 
  • However, constipation rate was lower with colchicine: 
    • 4.8% vs 19.3%.
    • Imputed OR, 0.24 (P <.001).
  • Colchicine was more costly and less cost-effective in a willingness-to-pay model.





Limitations

  • Open-label design.
  • No assessment of comorbidities, prior flares, or use of urate-lowering therapies.

Key messages
What is already known about this subject?
► Non-steroidal anti-inflammatory drugs (NSAIDs)
are effective treatments for gout flare, but side
effects are frequent.
► Lower doses of colchicine are as effective as
and better tolerated than high doses but have
never been compared directly with an NSAID.
What does this study add?
► There was no difference between the effect of
naproxen and low-dose colchicine on pain from
gout flare.
► Naproxen was associated with fewer side
effects, lower use of other analgesics and was
cost-effective.
How might this impact on clinical practice or
future developments?
► In the absence of contraindications, naproxen
should be used ahead of low-dose colchicine in
primary care on the grounds of effectiveness,
safety and cost.



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Categories: Gout

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Methods and regimens for effective treatment of gout – Arthritisco · July 4, 2020 at 1:38 pm

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