Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care

Roddy, Edward; Clarkson, Kris; Blagojevic‐Bucknall, Milica; Mehta, Rajnikant; Oppong, Raymond; Avery, Anthony J; Hay, Elaine M; Heneghan, Carl; Hartshorne, Liz; Hooper, Julie; Hughes, Gemma; Jowett, Sue; Lewis, Martyn; Little, Paul; McCartney, Karen; Mahtani, Kamal R; Nunan, David; Santer, Miriam; Williams, Samantha; Mallen, Christian

doi:10.1136/annrheumdis-2019-216154

Cited by 44 publications

(62 citation statements)

References 29 publications

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“… 85 An open-label randomised trial comparing low-dose colchicine 500 mg three times per day for 4 days with naproxen 750 mg immediately, then 250 mg every 8 hours for 7 days found that there was no difference between the two groups in terms of pain intensity over 7 days although side effects were more common in the colchicine group, mainly diarrhoea and headache. 86 Another randomised trial comparing oral prednisone and naproxen for monoarticular gout found that either prednisolone 35 mg once a day or naproxen 500 mg two times a day for 5 days were equally effective, and adverse effects were similar between groups. 33 Symptomatic treatment for a gout flare includes immobilisation of the joint and use of cold packs.…”

Section: Resultsmentioning

confidence: 99%

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout

et al. 2021

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ObjectiveTo develop a Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout, with the goal of increasing public understanding and awareness, and ensure consistent and understandable messages about gout.MethodsA G-CAN working group that included patients, physicians and nongovernmental organisation (NGO) representatives was formed to develop a common language definition of gout for use with the public, media, healthcare providers and stakeholders. A literature search and interviews with patients, healthcare workers and stakeholders informed development of the definition. Following consultation with G-CAN members and partners, the definition was endorsed by the G-CAN board.ResultsThe G-CAN common language definition of gout describes the epidemiology, pathophysiology, symptoms and impact, risk factors, comorbidities, management and healthcare and workforce considerations. Detailed information is provided to support the content of the definition. After the publication of the English-language version, the definition will be available for translation into other languages by G-CAN members.ConclusionG-CAN has developed a concise and easily understandable statement describing gout in language that can be used in conversations with the lay public, media, NGOs, funders, healthcare providers and other stakeholders.

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Section: Resultsmentioning

confidence: 99%

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout

et al. 2021

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“…Nineteen RCTs (3,560 patients, 9 interventions) described the change in pain from baseline at day 2 (15–32). The reference (i.e., acetic acid derivative NSAIDs) showed an important average reduction in pain from baseline to day 2 (MD –30.67 [95% CI –31.89, –29.45] on a 0 to 100 VAS; very low certainty; MID –19) (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…The NMA for change in pain at the longest follow‐up (median 7 days, range 3–28 days) included 16 RCTs (2,384 patients, 9 interventions) (16–19,21–26,28–32). Of the 36 pairwise comparisons between interventions, direct evidence was available for 11.…”

Section: Resultsmentioning

confidence: 99%

“…SAE. The NMA for SAEs included 29 RCTs (4,248 patients, 13 interventions) (15)(16)(17)(18)(19)(20)(21)(22)(23)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) and 78 paired estimates, of which 15 had both direct and indirect evidence and 58 had only indirect evidence. The median duration of available follow-up was 8 days (range 5-365 days).…”

Section: Effects Of the Interventionsmentioning

confidence: 99%

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Efficacy and Safety of Pharmacologic Interventions in Patients Experiencing a Gout Flare: A Systematic Review and Network Meta‐Analysis

Zeng

Qasim

Neogi

et al. 2021

Arthritis Care & Research

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Objective To compare the relative efficacy and safety of pharmacologic antiinflammatory interventions for gout flares. Methods We searched Ovid Medline, Embase, and Cochrane library for randomized controlled trials (RCTs) that compared pharmacologic antiinflammatory 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 Grading of Recommendations Assessment, Development, and Evaluation for NMA. Results In the 30 eligible RCTs, canakinumab provided the highest pain reduction at day 2 and at longest follow‐up (mean difference relative to acetic acid derivative nonsteroidal antiinflammatory drugs [NSAIDs] –41.12 [95% confidence interval (95% CI) –53.36, –29.11] on a 0–100 scale at day 2, and mean difference –12.84 [95% CI –20.76, –4.91] at longest follow‐up; both moderate certainty; minimum important difference –19). Intravenous or intramuscular corticosteroids were 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 2. Acetic acid derivative NSAIDs improved joint swelling better than ibuprofen NSAIDs at day 2 (mean difference –0.29 [95% CI –0.56, –0.02] on a 0–4 scale; moderate certainty) and improved patient global assessment (PtGA) greater than ibuprofen NSAIDs at the longest follow‐up (mean difference –0.44 [95% CI –0.86, –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 ibuprofen NSAIDs in improving joint swelling and PtGA.

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“…Interestingly, though we welcomed a recently advertised breakthrough that low-dose aspirin, one of the NSAIDs, has shown a significant COVID-19 survival benefit [ 46 ], we have heavily criticized the integrity of its analysis according to our academic experience [ 47 ]. Similarly, we consider that colchicine, which is used mainly in treatment of gout, similarly advertised breakthrough [ https://app.cyberimpact.com/newsletter-view-online?ct=guhsMu_jogsWK5zuKuZWMiFdWXxrNhn6Nkcjb1fm-HUAuS81ZbwD0N6bKX9bJ23ALFDAfrG83CWBnSzT41zxRA ] might also prove valid, yet we wish to suggest that colchicine acts via an anti-inflammatory and immune-modulatory mechanisms [ 48 ] which are better achieved using the safer and more effective NSAIDs [ 49 ].…”

Section: Expert Opinionmentioning

confidence: 99%

NSAIDs/nitazoxanide/azithromycin repurposed for COVID-19: potential mitigation of the cytokine storm interleukin-6 amplifier via immunomodulatory effects

Kelleni

2021

Expert Review of Anti-infective Therapy

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Introduction: Mediators of immunity and inflammation are playing a crucial role in COVID-19 pathogenesis and complications as demonstrated by several genetic and clinical studies. Thus, repurposing of drugs that possess anti-inflammatory and/or immune-modulatory effects for COVID-19 is considered a rational approach. Areas covered: We analyze selected studies that correlated COVID-19 with dysregulated interferon and inflammatory responses while reflecting on our academic and real-life experience using non-steroidal anti-inflammatory drugs, nitazoxanide and azithromycin for management of COVID-19. Moreover, we interpret the results that suggested a potential survival benefit of low-dose aspirin and colchicine when used for COVID-19. Expert opinion: Nitazoxanide/azithromycin combination has been first hypothesized by the author and practiced by him and several researchers to benefit COVID-19 patients due to a potential ability to augment the natural interferon response as well as their positive immunomodulatory effects on several cytokines. Furthermore, NSAIDs, that are unfortunately currently at best of second choice after paracetamol, have been early postulated and clinically practiced by the author to prevent or ameliorate COVID-19 complications and mortality due to their anti-inflammatory and immunomodulatory properties. Finally, we repeat our previous call to adopt our observational study that used these drugs in sufficiently powered double blind randomized clinical trials.

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Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care

Cited by 44 publications

References 29 publications

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) common language definition of gout

Efficacy and Safety of Pharmacologic Interventions in Patients Experiencing a Gout Flare: A Systematic Review and Network Meta‐Analysis

NSAIDs/nitazoxanide/azithromycin repurposed for COVID-19: potential mitigation of the cytokine storm interleukin-6 amplifier via immunomodulatory effects

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