Abstract
Objective: The aim of this research was to determine how common gout flares are after ceasing anti-inflammatory prophylaxis.
Methods: A rapid literature review and meta-analysis were undertaken. PubMed was searched from inception to February 2024. Eligibility criteria included: any clinical trial of people with gout with at least one arm starting or intensifying ULT with co-prescription of anti-inflammatory prophylaxis, and the percentage of participants experiencing ≥ one gout flare reported during and after the period of prophylaxis. Random effects meta-analyses were used to generate pooled estimates of the percentage of participants experiencing ≥ one flare in each period.
Findings: Six trials included, together with aggregated, unpublished data from the VA-STOP Gout trial (2972 participants). Pooled random effects estimates (95% CI) of the percentage of participants having ≥ one gout flare were 14.7% (11.3%-18.5%) during prophylaxis, 29.7% (22.9%-37.0%) in the three-month period after ceasing prophylaxis and 12.2% (6.8%-19.0%) during the last study period. The mean difference in the percentage of participants having ≥ one gout flare while on prophylaxis and immediately after ceasing prophylaxis was -14.8.0% (-21.2% to -8.5%)(p<0.0001). The mean difference from the period immediately following prophylaxis discontinuation compared to the last study period was 16.0% (p<0.001). Sensitivity analyses indicated no material effects of prophylaxis duration, trial duration, ULT class, or placebo arms.
Interpretation: Gout flares are common after stopping anti-inflammatory prophylaxis but return to levels seen during prophylaxis. Patients should be cautioned about the risk of gout flares and have a plan for effective gout flare management in the three months after stopping anti-inflammatory prophylaxis.