geoffrey modest medical blogs

  A recent meta-analysis confirmed that gout needs to be treated with anti-inflammatory meds for longer than three months   after initiating urate-lowering meds  in order to decrease the risk of a recurrent flare  (see   gout flares high after stopping prophy ArthCareRes2024  in dropbox, or DOI 10.1002/acr.25486)   Details: --researchers found 6 trials in the literature and one with aggregated unpublished data from the VA (the VA STOP Gout trial), with a total of 2972 participants     -- these trials were chosen because they had at least one study arm with starting or intensifying urate-lowering therapy (ULT) in which anti-inflammatory prophylaxis was prescribed; these included trials needed to report the percentage of participants with at least one gout flare both during and after the period of anti-inflammatory prophylaxis was  documented  -- trial durations ranged from 24 to 104 weeks, and anti-inflammatory prophylaxis durations ...

  I am very sorry but there was an error in my reading of the article for this blog (which was sent out as below): I misread their conclusion “placebo is not non-inferior to colchicine in prevention of gout flares in the first 6 months of starting allopurinol using the ‘start-low go-slow’ strategy” with the double negative.  Sorry about that. I would restate my conclusions as follows:  --------------------------------------------------------------------- -- placebo was not non-inferior to colchicine in the primary outcome of 6 month followup. Colchicine did in fact help -- this was not true at the secondary outcome of analysis at 12 months, largely because of an increased risk of gout for 3 months after cessation of the colchicine (ie, it all evened out at 12 months) -- the reason why this skewed effect happened might well be from the fact that it took 3 months for the allopurinol plus colchicine to get the serum urate levels below their target of 6 mg/dL, which might sug...