Prevention of gout flares at the start of urate-lowering therapy in patients with cardiovascular disease
Abstract
Gout is a chronic disease caused by the deposition of monosodium urate crystals in tissues, which most commonly manifests as inflammatory arthritis with a marked pain syndrome. Gout is often combined with cardiovascular disease and is an independent risk factor for cardiovascular events. Treatment includes managing exacerbations and taking medications to reduce uric acid levels to target values that ensure the absence of flares. At the beginning of urate-lowering therapy, many patients may experience exacerbations of arthritis. In order to prevent them, anti-inflammatory prophylaxis is carried out. The main drugs for anti-inflammatory prophylaxis are colchicine, nonsteroidal anti-inflammatory drugs, glucocorticoids. The optimal drug for anti-inflammatory prophylaxis of gout exacerbations in persons with cardiovascular disease should meet several requirements: effectively prevent gout exacerbations, have no contraindications for prescription in cardiovascular disease, and, ideally, reduce cardiovascular risks. The purpose of this review is to analyze the most commonly used drugs for compliance with these requirements.
References
1. Gout / N. Dalbeth [et al.] // Nat Rev Dis Primer. — 2019. — Vol. 5, № 1. — P. 69.
2. Singh, J. A. Gout epidemiology and comorbidities / J. A. Singh, A. Gaffo // Semin. Arthritis Rheum. — 2020. — Vol. 50, № 3. — P. 11—16.
3. Bidirectional Association between Self-Reported Hypertension and Gout: The Singapore Chinese Health Study / A. Pan [et al.] // PloS One. — 2015. — Vol. 10, № 10. — P. e0141749.
4. Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK clinical practice research datalink / L.E. Clarson [et al.] // Ann Rheum Dis. — 2015. — Vol. 74, № 4. — P. 642—647.
5. Association of Gout with Cad and Effect of Antigout Therapy on Cvd Risk among Gout Patients / W.-S. Huang [et al.] // J. Investig Med. — 2020. — Vol. 68, № 5. — P. 972—979.
6. Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis / L. E. Clarson [et al.] // Eur. J. Prev. Cardiol. — 2015. — Vol. 22, № 3. — P. 335—343.
7. American College of Rheumatology Guideline for the Management of Gout / J. D. FitzGerald [et al.] // Arthritis Rheumatol Hoboken NJ. — 2020. — Vol. 72, № 6. — P. 744—760.
8. Консенсус для врачей по ведению пациентов с бессимптомной гиперурикемией в общетерапевтической практике / О. М. Драпкина [и др.] // Кардиоваскулярная терапия и профилактика — 2024. — Т. 23, № 1. — С. 3737.
9. The Effect of Decrease in Serum Urate for the Risk of Gout Flares During Urate-Lowering Therapy Initiation Among Chinese Male Gout Patients: A Prospective Cohort Study / L. Pang [et al.] // J. Inflamm. Res. — 2023. — Vol. 16 — P. 3937—3947.
10. Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims / A. A. Riedel [et al.] // J. Rheumatol. — 2004. — Vol. 31, № 8. — P. 1575—1581.
11. Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout / E. Cipolletta [et al.] // JAMA. — 2022. — Vol. 328, № 5. — P. 440—450.
12. 2016 updated EULAR evidence-based recommendations for the management of gout / P. Richette [et al.] // Ann. Rheum. Dis. — 2017. — Vol. 76, № 1. — P. 29—42.
13. The British Society for Rheumatology Guideline for the Management of Gout / M. Hui [et al.] // Rheumatol. Oxf. Engl. — 2017 — Vol. 56, № 7. — P. 1—20.
14. Prophylaxis of acute flares when initiating febuxostat for chronic gouty arthritis in a real-world clinical setting / J. Yu [et al.] // Mod. Rheumatol. — 2018. — Vol. 28, № 2. — P. 339—344.
15. Latourte, A. Prophylaxis for acute gout flares after initiation of urate-lowering therapy / A. Latourte, T. Bardin, P. Richette // Rheumatol. Oxf. Engl. — 2014. — Vol. 53, № 11. — P. 1920—1926.
16. Чикина, М. Н. Сравнение эффективности и безопасности различных противовоспалительных препаратов при инициации уратснижающей терапии у пациентов с подагрой (предварительные данные) / М. Н. Чикина, М. С. Елисеев, О. В. Желябина // Современная Ревматология. — 2021. — Vol. 15, № 2. — С. 50—56.
17. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis / G. C. Borstad [et al.] // J. Rheumatol. — 2004. — Vol. 31, № 12. — P. 2429—2432.
18. Billy, C. A. Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout : A Systematic Review of Randomized Controlled Trials / C. A. Billy [et al.] // J. Rheumatol. — 2018. — Vol. 45, № 1. — P. 128—136.
19. Colchicine in Cardiovascular Disease : In Depth Review / S. G. Deftereos [et al.] // Circulation. — 2022. — Vol. 145, № 1. — P. 61—78.
20. Алекберова, З. С. Перспективы применения колхицина в медицине: новые данные / З. С. Алекберова, Е. Л. Насонов // Научно-практическая ревматология. — 2020. — Т. 58, № 2. — С. 183—190.
21. Tardif, J.-C. Efficacy and safety of low-dose colchicine after myocardial infarction / J.-C. Tardif [et al.] // N. Engl. J. Med. — 2019. — Vol. 381, № 26. — P. 2497—2505.
22. Colchicine in Patients with Chronic Coronary Disease / S. M. Nidorf [et al.] // N. Engl. J. Med. — 2020. — Vol. 383, № 19. — P. 1838—1847.
23. ESC Guidelines on cardiovascular disease prevention in clinical practice / F. L. J. Visseren [et al.] // Eur. Heart J. — 2021. — Vol. 43, № 42. — P. 4468.
24. Risk of coronary artery disease in patients with gout on treatment with Colchicine : A systematic review and meta-analysis/ M. U. Siddiqui [et al.] // IJC Heart Vasc. — 2023. — Vol. 45 — P. 101—191.
25. Safety of colchicine and NSAID prophylaxis when initiating urate-lowering therapy for gout: propensity score-matched cohort studies in the UK Clinical Practice Research Datalink / E. Roddy [et al.] // Ann. Rheum. Dis. — 2023. — Vol. 82, № 12. — P. 1618—1625.
26. Adverse events during oral colchicine use: a systematic review and meta-analysis of randomised controlled trials / S. Stewart [et al.] // Arthritis. Res. Ther. — 2020. — Vol. 22, № 1. — P. 28.
27. Consensus Statement Regarding the Efficacy and Safety of Long-Term Low-Dose Colchicine in Gout and Cardiovascular Disease / P. C. Robinson [et al.] // Am. J. Med. — 2022. — Vol. 135, № 1. — P. 32—38.
28. Quality of gout care in the emergency departments: a multicentre study / P. Towiwat [et al.] // BMC Emerg. Med. — 2020. — Vol. 20. — P. 27.
29. Cardiovascular safety of non-aspirin nonsteroidal anti-inflammatory drugs: review and position paper by the working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology / M. Schmidt [et al.] // Eur. Heart. J. — 2016. — Vol. 37, № 13. — P. 1015—1023.
30. Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis / E. Nissen Steven [et al.] // N. Engl. J. Med. — 2016. — Vol. 375, № 26. — P. 2519—2529.
31. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/ APLAR/APSDE/APSH/APSN/PoA recommendations / C-C. Szeto [et al.] // Gut. — 2020. — Vol. 69, № 4. — P. 617—629.
32. Comparative Risks of Nonsteroidal Antiinflammatory Drugs on Cardiovascular Diseases: A Population-Based Cohort Study / E. Y. F. Wan [et al.] // J. Clin. Pharmacol. — 2023. — Vol. 63, № 1. — P. 126—134.
33. Wei, L. Taking Glucocorticoids by Prescription Is Associated with Subsequent Cardiovascular Disease / L. Wei, T. M. MacDonald, B. R. Walker // Ann. Intern. Med. — 2004. — Vol. 141, № 10. — P. 764—770.
34. The role of glucocorticoids in increasing cardiovascular risk / H.-W. Deng [et al.] // Front. Cardiovasc. Med. — 2023. — Vol. 10. — P. 1187100.
35. Rapid reduction in uric acid by a urate-lowering agent is associated with recurrent cardiovascular events / J. S. Lee [et al.] // Med. Hypotheses. — 2020. — Vol. 141. — P. 109740.
36. Stepwise dose increase of febuxostat is comparable with colchicine prophylaxis for the prevention of gout flares during the initial phase of urate-lowering therapy : results from FORTUNE-1, a prospective, multicentre randomised study / H. Yamanaka [et al.] // Ann. Rheum. Dis. — 2018. — Vol. 77, № 2. — P. 270—276.
37. Is colchicine prophylaxis required with start-low go-slow allopurinol dose escalation in gout? A noninferiority randomised double-blind placebo-controlled trial / L. Stamp [et al.] // Ann. Rheum. Dis. — 2023. — Vol. 82, № 12. — P. 1626—1634.
Review
For citations:
Chyzh M.V. Prevention of gout flares at the start of urate-lowering therapy in patients with cardiovascular disease. Healthcare. 2024;(10):29-36. (In Russ.)
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