Naproxen Can Be a First-Line Treatment for Gout

By Marilynn Larkin

November 14, 2019

NEW YORK (Reuters Health) - In patients with gout, naproxen was associated with similar pain relief, fewer side effects and lower use of other analgesics compared to low-dose colchicine, a multicenter open-label randomized trial suggests.

Dr. Edward Roddy of Keele University, UK recruited adults with a gout flare from 100 general practices and randomized them to naproxen 750 mg immediately, then 250 mg every eight hours for seven days, or low-dose colchicine 500 mcg three times daily for four days. Outcomes were assessed by a self-completed diary at day 7, and a questionnaire at week 4.

As reported online October 30 in the Annals of Rheumatic Diseases, 349 participants completed the primary outcome data - change in worst pain intensity in the previous 24 hours, at day 7.

Participants' mean age was about 59; about 87% men; and the mean age at diagnosis was 53.

No significant between-group difference in average pain change was observed over days 1-7 (colchicine vs. naproxen: mean difference, −0.18). However, in the same period, diarrhea was more common with colchicine (49%) than with naproxen (20%; odds ratio, 3.31), as was headache (20.5% vs. 10.7%; OR, 1.92).

By contrast, constipation was less common with colchicine (4.8% vs. 19.3%; OR, 0.24).

More participants in the colchicine group used paracetamol/acetaminophen or codeine for gout during days 1-7 than in the naproxen group. However, there were no between-group differences in complete pain resolution or patient global assessment of treatment response at any point.

At week 4, there were no between-group differences in the proportions of participants reporting a relapse/recurrent gout flare; consulting a GP, practice nurse or emergency department; or time off work. However, ibuprofen use was more common in the colchicine group.

Three serious adverse events occurred during the study, none related to trial interventions, and no deaths.

The authors state, "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."

Rheumatologist Dr. Kamini Shah of Northwell Health in Queens, New York City, commented in an email to Reuters Health, "The findings...are compelling since it's the first head-to-head trial comparing NSAIDS to colchicine for acute gout flares. Not surprisingly, the dosing used in each arm resulted in no significant difference in pain reduction."

"In current practice, due to its similar efficacy, we use both these therapeutic agents to treat gout," she noted. "Physicians, however, should remain vigilant (because) NSAIDS can increase blood pressure, cause heart failure and kidney disease, and increase risk for heart attacks and strokes. Thus, they should generally be avoided in the elderly population."

"In the same vein, one should use caution when starting colchicine while a patient is on a lipid -lowering statin drug therapy to avoid potential muscle toxicity risks," she noted. "Moreover, dosing for both therapies require adjustment for patients with kidney disease."

"Appropriately, cardiac and renal patients were excluded from this study," she added. "Moreover, neither blood pressure measurements nor kidney functioning were prospectively followed while patients were on naproxen therapy."

"Physicians and patients, together, should review medication lists carefully before starting gout therapy," she advised. "There is no ideal regimen for treating gout as each patient presents with a unique profile."

Dr. N. Lawrence Edwards, Chairman of the Gout Education Society and vice chairman of the department of medicine at the University of Florida at Gainesville, told Reuters Health the study "confirms what we've seen in previous studies for the treatment of acute gout symptoms or for maintenance. If a therapy is started early enough in the flare, there should be about 50% improvement of pain and most of the pain should be gone after 5-7 days."

Like Dr. Shah, he noted that no single drug will be universally effective. "The study points out that even our standard therapies don't relieve gout pain fast enough during a flare," he said by email. "If you can imagine the worst pain you've ever had, and you're given a drug and told that a day and a half from now its still liable to be 50% of what it is right now, you probably wouldn't be happy about that. So, we need better therapies."

Dr. Roddy did not respond to requests for a comment.


Ann Rheum Dis 2019.


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