Abstract:
OBJECTIVE:To compare the relative efficacy and safety of pharmacological anti-inflammatory interventions for gout flares. METHODS:We searched Ovid Medline, Embase and Cochrane library for randomized controlled trials (RCTs) that compared pharmacological anti-inflammatory treatment of gout flares. We conducted a network meta-analysis (NMA) using a frequentist framework, and assessed the certainty of evidence and made conclusions using the GRADE for NMA. RESULTS:In the 30 eligible RCTs, canakinumab provided the highest pain reduction at day two and at longest follow-up (Mean difference [MD] relative to acetic acid derivative non-steroidal anti-inflammatory drugs [NSAIDs] -41.12, 95% confidence interval [CI] -53.36 to -29.11 on a 0 to 100 scale at day two; MD -12.84, 95% CI -20.76 to -4.91 at longest follow-up; both moderate certainty; MID -19). Intravenous or intramuscular corticosteroids was inferior to canakinumab but may be better than the other commonly used interventions (low to very low certainty). For joint tenderness, canakinumab may be the most effective intervention at day two. Acetic acid derivative NSAIDs improved joint swelling better than profen NSAIDs at day two (MD -0.29, 95% CI -0.56 to -0.02 on a 0 to 4 scale; moderate certainty) and improved patient global assessment (PGA) greater than profen NSAIDs at the longest follow-up (MD -0.44, 95% CI -0.86 to -0.02; moderate). CONCLUSION:Canakinumab may be superior to other alternatives and intravenous or intramuscular corticosteroids may be the second best in pain reduction. Acetic acid derivative NSAIDs may be superior to profen NSAIDs in improving joint swelling and patient global assessment.
