Inflammopharmacology

, Volume 26, Issue 3, pp 717–723 | Cite as

Oral prednisolone versus non-steroidal anti-inflammatory drugs in the treatment of acute gout: a meta-analysis of randomized controlled trials

  • Jie Yu
  • Haimei Lu
  • Jia Zhou
  • Zhijun Xie
  • Chengping Wen
  • Zhenghao Xu
Original Article
  • 77 Downloads

Abstract

Objectives

To evaluate the efficacy and safety of oral prednisolone in the treatment of acute gout compared with non-steroidal anti-inflammatory drugs (NSAIDs).

Methods

A comprehensive search of databases in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors.

Results

Three double-blind, randomized, controlled trials were included in the final analysis, with a total of 584 patients. Regarding the efficacy, oral prednisolone (30–35 mg/day) was comparable with NSAIDs (naproxen at 500 mg/day or indomethacin at 50–100 mg/day) on the pain relief scale, both in activity (difference in means 0.259, 95% CI − 1.532 to 2.050, P = 0.777) and at rest (difference in means − 0.502, 95% CI − 4.961 to 3.956, P = 0.825) during the first 2–6 h. During the following 4 to 6 days, prednisolone acted with comparable efficacy either in activity (difference in means − 0.552, 95% CI − 1.364 to 0.260, P = 0.183) or at rest (difference in means − 0.164, 95% CI − 0.463 to 0.134, P = 0.281). Regarding safety, prednisolone did not increase the total adverse events (AEs) (risk ratios [RR] 0.765, 95% CI 0.473 to 1.238, P = 0.275) and reduced the withdrawal rate because of the AEs (RR 0.127, 95% CI 0.021–0.763, P = 0.024). Prednisolone decreased the risks of several AEs (including indigestion: RR 0.544, 95% CI 0.311–0.952, P = 0.033; nausea: RR 0.296, 95% CI 0.136–0.647, P = 0.002; and vomiting: RR 0.155, 95% CI 0.033–0.722, P = 0.018) but increased the risk of skin rashes (RR 4.049, 95% CI 1.241–13.158, P = 0.021).

Conclusions

Oral prednisolone may be of similar efficacy and a slightly safer strategy for treatment of active, acute gout compared with NSAIDs. Further clinical studies are still warranted to investigate its long-term efficacy and safety.

Keywords

Acute gout Prednisolone NSAIDs Pain Meta-analysis 

Abbreviations

ACR

American College of Rheumatology

AE

Adverse event

CFDA

China Food and Drug Administration

ChiCTR

Chinese Clinical Trial Register

CI

Confidence interval

EULAR

European League against Rheumatism

NSAIDs

Non-steroidal anti-inflammatory drugs

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RRs

Risk ratios

Notes

Acknowledgements

This work was funded by the Zhejiang Provincial Natural Science Foundation of China (LY16H280005 and LQ16H270004), and partly by the National Natural Science Foundation of China (81673623 and 81603088). Z.Xu. and C.W. designed study; J.Y., H.L., and Z. Xu performed research and analyzed data; Z.J. and Z. Xie Contributed suggestion & discussion; Z. Xu wrote the paper.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

10787_2018_442_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 kb)

References

  1. Abhishek A, Roddy E, Doherty M (2017) Gout - a guide for the general and acute physicians. Clin Med 17:54–59CrossRefGoogle Scholar
  2. Billy CA, Lim RT, Ruospo M, Palmer SC, Strippoli GFM (2018) Corticosteroid or nonsteroidal antiinflammatory drugs for the treatment of acute gout: a systematic review of randomized controlled trials. J Rheumatol 45:128–136CrossRefPubMedGoogle Scholar
  3. Cattermole GN, Man CY, Cheng CH, Graham CA, Rainer TH (2009) Oral prednisolone is more cost-effective than oral indomethacin for treating patients with acute gout-like arthritis. Eur J Emerg Med 16:261–266CrossRefPubMedGoogle Scholar
  4. Chinese Rheumatology Association (2016) 2016 Chinese guidelines to diagnosis and treatment of gout [in Chinese]. Chin J Intern Med 55:892–899Google Scholar
  5. Cui M, Liu Z (2016) The clinical effect of different analgesic anti-inflammatory solution in the treatment of acute gouty arthritis [in Chinese]. Chin J of Clinical Rational Drug Use 9:30–35Google Scholar
  6. Czock D, Keller F, Rasche FM, Haussler U (2005) Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet 44:61–98CrossRefPubMedGoogle Scholar
  7. Dalbeth N, Merriman TR, Stamp LK (2016) Gout. Lancet (London, England) 388:2039–2052CrossRefGoogle Scholar
  8. Friedrich JO, Adhikari NK, Beyene J (2007) Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available data. BMC Med Res Methodol 7:5CrossRefPubMedPubMedCentralGoogle Scholar
  9. Janssens HJ, Lucassen PL, Van de Laar FA, Janssen M, Van de Lisdonk EH (2008a) Systemic corticosteroids for acute gout. The Cochrane database of systematic reviews: CD005521Google Scholar
  10. Janssens HJEM, Janssen M, van de Lisdonk EH, van Riel PLCM, van Weel C (2008b) Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet London, England 371:1854–1860CrossRefPubMedGoogle Scholar
  11. Liu X, Sun D, Ma X, Li C, Ying J, Yan Y (2017) Benefit-risk of corticosteroids in acute gout patients: an updated meta-analysis and economic evaluation. Steroids 128:89–94CrossRefPubMedGoogle Scholar
  12. Man CY, Cheung ITF, Cameron PA, Rainer TH (2007) Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial. Ann Emerg Med 49:670–677CrossRefPubMedGoogle Scholar
  13. McGettigan P, Henry D (2011) Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med 8:e1001098CrossRefPubMedPubMedCentralGoogle Scholar
  14. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRefPubMedPubMedCentralGoogle Scholar
  15. Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y (2001) Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 12:232–236CrossRefPubMedGoogle Scholar
  16. Pereira-Leite C, Nunes C, Jamal SK, Cuccovia IM, Reis S (2017) Nonsteroidal anti-inflammatory therapy: a journey toward safety. Med Res Rev 37:802–859CrossRefPubMedGoogle Scholar
  17. Qaseem A, Harris RP, Forciea MA, Clinical Guidelines Committee of the American College of, P (2017) Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 166:58–68CrossRefPubMedGoogle Scholar
  18. Rainer TH, Cheng CH, Janssens HJEM, Man CY, Tam LS, Choi YF, Yau WH, Lee KH, Graham CA (2016) Oral prednisolone in the treatment of acute gout a pragmatic, multicenter, double-blind, randomized trial. Ann Intern Med 164:464–471CrossRefPubMedGoogle Scholar
  19. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, Liote F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T (2017) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 76:29–42CrossRefPubMedGoogle Scholar
  20. Shekelle PG, Newberry SJ, FitzGerald JD, Motala A, O’Hanlon CE, Tariq A, Okunogbe A, Han D, Shanman R (2017) Management of gout: a systematic review in support of an american college of physicians clinical practice guideline. Ann Intern Med 166:37–51CrossRefPubMedGoogle Scholar
  21. van Walsem A, Pandhi S, Nixon RM, Guyot P, Karabis A, Moore RA (2015) Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis. Arthritis Res Ther 17:66CrossRefPubMedPubMedCentralGoogle Scholar
  22. Wang X, Zu Y, Huang L, Yu J, Zhao H, Wen C, Chen Z, Xu Z (2017) Treatment of rheumatoid arthritis with combination of methotrexate and Tripterygium wilfordii: a meta-analysis. Life Sci 171:45–50CrossRefPubMedGoogle Scholar
  23. Wechalekar MD, Vinik O, Moi JH, Sivera F, van Echteld IA, van Durme C, Falzon L, Bombardier C, Carmona L, Aletaha D, Landewe RB, van der Heijde DM, Buchbinder R (2014) The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors. J Rheumatol Supplement 92:15–25Google Scholar
  24. Xu L, Liu S, Guan M, Xue Y (2016a) Comparison of prednisolone, etoricoxib, and indomethacin in treatment of acute gouty arthritis: an open-label, randomized, controlled trial. Med Sci Monit 22:810–817CrossRefPubMedPubMedCentralGoogle Scholar
  25. Xu Z, Zhao H, Chen Z (2016b) The efficacy and safety of rufinamide in drug-resistant epilepsy: a meta-analysis of double-blind, randomized, placebo controlled trials. Epilepsy Res 120:104–110CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of Basic Medical ScienceZhejiang Chinese Medical UniversityHangzhouChina

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