Gout Flares After Stopping Anti-Inflammatory Prophylaxis: A Rapid Literature Review and Meta-Analysis.

Objective: The aim of this research was to determine how common gout flares are after ceasing anti-inflammatory prophylaxis.

Methods: A rapid literature review and meta-analysis were undertaken. PubMed was searched from inception to February 2024. Eligibility criteria included any clinical trial of people with gout with at least one arm starting or intensifying urate-lowering therapy (ULT) with coprescription of anti-inflammatory prophylaxis and that had the percentage of participants experiencing one or more gout flares reported during and after the period of prophylaxis. Random effects meta-analyses were used to generate pooled estimates of the percentage of participants experiencing one or more flares in each period.

Results: Six trials were included, together with aggregated, unpublished data from the VA STOP Gout trial (2,972 participants). Pooled random effects estimates of the percentage of participants having one or more gout flares were 14.7% (95% confidence interval [CI] 11.3-18.5%) during prophylaxis, 29.7% (95% CI 22.9-37.0%) in the three-month period after ceasing prophylaxis, and 12.2% (95% CI 6.8-19.0%) during the last study period. The mean difference in the percentage of participants having one or more gout flare while taking prophylaxis and immediately after ceasing prophylaxis was -14.8.0% (95% CI -21.2% to -8.5%; P < 0.0001). The mean difference from the period immediately following prophylaxis discontinuation compared to the last study period was 16.0% (P < 0.001). Sensitivity analyses indicated no material effects of prophylaxis duration, trial duration, ULT class, or placebo arms.

Conclusion: Gout flares are common after stopping anti-inflammatory prophylaxis but return to levels seen during prophylaxis. Patients should be cautioned about the risk of gout flares and have a plan for effective gout flare management in the three months after stopping anti-inflammatory prophylaxis.