Naproxen recommended over low-dose colchicine for gout flares
medwireNews: Naproxen and low-dose colchicine are similarly effective in the reduction of pain associated with gout flares, but patients receiving colchicine tend to experience more side-effects, show results from the multicenter, open-label CONTACT trial.
“In the absence of contraindications, naproxen should be used ahead of low-dose colchicine in primary care on the grounds of effectiveness, safety and cost,” Edward Roddy (Keele University, UK) and colleagues write in the Annals of the Rheumatic Diseases.
The researchers found that among the 200 patients with a gout flare who were randomly assigned to received naproxen 750 mg immediately then 250 mg every 8 hours for 7 days, the mean pain score fell from 6.7 points (on a validated 0–10 Numeric Rating Scale) on day 1 to 1.4 points on day 7.
By comparison, the mean score fell from 6.5 to 1.5 points among the 199 patients randomly assigned to receive colchicine 500 µg every 8 hours for 4 days.
After adjustment for age, sex, and baseline pain score, there was no significant difference between the two groups in the change in worst pain intensity averaged over days 1–7, at 3.8 versus 3.5 points for naproxen and colchicine, respectively.
There were also no differences between the two groups at any time point in the level of complete pain resolution or patient global assessment of treatment response.
Furthermore, at week 4, the proportion of patients reporting a relapse/recurrent gout flare, consulting a primary care provider, practice nurse, or emergency department, or needing time off work was similar between the groups.
However, Roddy and team found that fewer people taking naproxen used paracetamol (13.4 vs 23.6%) or codeine (4.7 vs 14.6%) for gout during days 1–7 than did those taking colchicine, and a smaller proportion of the former versus the latter group reported side effects (60.7 vs 69.2%).
Specifically, the rates of diarrhea and headache were a significant 3.3- and 1.9-fold higher, respectively, with colchicine than with naproxen (45.9 vs 20.0% and 20.5 vs 10.7%, respectively).
The only side effect less common with colchicine than with naproxen was constipation, which occurred in 4.8% versus 19.3% of participants (odds ratio=0.24).
The CONTACT (Colchicine Or Naproxen Treatment for ACute gout) investigators also calculated that naproxen was slightly cheaper and more effective than colchicine; at a willingness-to-pay threshold of £ 20,000 (US$ 25,836; € 23,147) per quality-adjusted life–year, naproxen had an 80% chance of being cost-effective relative to colchicine, they report.
By Laura Cowen
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