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Use NSAID naproxen over low-dose colchicine for gout flares treatment, suggests BMJ study


Use NSAID naproxen over low-dose colchicine for gout flares treatment, suggests BMJ study

UK: A recent study on patients with gout flares found both naproxen and low-dose colchicine to be equally effective for reduction in pain intensity when administered to the patients over 7 days. However, the use of NSAID naproxen caused fewer side effects supporting it as the first-line treatment for gout flares in primary care in the absence of contraindications. The study is published in the BMJ journal Annals of the Rheumatic Diseases.

Mayo Clinic defines gout as a common and complex form of arthritis that can affect anyone. It is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe. Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares.

“Non-steroidal anti-inflammatory drugs (NSAIDs) are effective treatments for gout flare, but side effects are frequent and can be life-threatening. High-dose colchicine is effective but commonly causes gastrointestinal side effects. Lower doses are as effective but better tolerated. However, a  direct comparison of an NSAID and low-dose colchicine needed to inform choice for patients and practitioners has not been done till now,” the authors write in the journal.

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Edward Roddy, Keele UniversityKeele, UK, and colleagues compared the effectiveness and safety of naproxen and low-dose colchicine for treating gout flares in primary care.
This multicentre open-label randomised trial recruited 399 participants between 29 January 2014 and 31 December 2015. They were randomly equally to naproxen 750 mg (n=200) immediately then 250 mg every 8 hours for 7 days or low-dose colchicine 500 mcg (n-199) three times per day for 4 days.
The primary outcome was a change in worst pain intensity in the last 24 hours (0–10 Numeric Rating Scale) from baseline measured daily over the first 7 days: mean change from baseline was compared between groups over days 1–7 by intention to treat. 349 (87.5%) of the participants completed primary outcome data at day 7.
Key findings of the study include:
  • There was no significant between-group difference in average pain-change scores over days 1–7 (colchicine vs naproxen: mean difference −0.18).
  • During days 1–7, diarrhoea (45.9% vs 20.0%) and headache (20.5% vs 10.7%) were more common in the colchicine group than the naproxen group but constipation was less common (4.8% vs 19.3%).

“We found little difference in pain reduction between naproxen and low-dose colchicine, but naproxen was associated with fewer side effects, less analgesic use and slightly lower costs, suggesting that, in the absence of contraindications, naproxen should be used ahead of low-dose colchicine to treat gout flares in primary care,” concluded the authors.

More Information: “Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care” published in the BMJ journal Annals of the Rheumatic Diseases.

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DOI: http://dx.doi.org/10.1136/annrheumdis-2019-216154

Journal Information: Annals of the Rheumatic Diseases




Source: Annals of the Rheumatic Diseases

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