The quality of evidence is downgraded by study limitations (unclear allocation concealment).
A Cochrane review included 23 studies with a total of 2 200 subjects. The aim of the review was to assess the benefit and safety of non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 inhibitors (COXIBs) for acute gout. Only one study compared an NSAID (tenoxicam 40 mg) with placebo. Four studies compared a conventional NSAID (indomethacin) with a selective COX-2 inhibitor (etoricoxib, celecoxib or lumiracoxib). Two studies compared NSAIDs (naproxen or indomethacin) with oral glucocorticoids (prednisolone 30 or 35 mg once daily).
Main results for the comparison of tenoxicam versus placerbo are shown in table .
| Outcome | Relative effect (95% CI) | Assumed risk - placebo | Corresponding risk - NSAID | Participants (studies) |
|---|---|---|---|---|
| *Proportion with ≥ 50% improvement, follow-up: 4 days; ** follow-up 11 days | ||||
| Pain improvement by 50% in 24 hours | RR 2.75 (1.13 to 6.72) | 267 per 1000 | 734 per 1000 (302 to 1000) | 30 (1 study) |
| Inflammation - joint swelling improvement* | RR 1.08 (0.79 to 1.49) | 800 per 1000 | 864 per 1000 (632 to 1000) | 30 (1 study) |
| Adverse events ** | RR 0.2 (0.01 to 3.85) | 133 per 1000 | 27 per 1000 (1 to 513) | 30 (1 study) |
NSAIDs and COXIBs produced similar benefits in terms of pain, swelling and global improvement, but COXIBs were associated with fewer adverse events (table ). There were significantly fewer gastrointestinal adverse events with COXIBs compared with traditional NSAIDs (6% versus 16; RR 2.35, 95% CI 1.59 to 3.48) and fewer cardiovascular events with COXIBs compared with traditional NSAIDs (7% versus 16%; RR 2.40, 95% CI 1.01 to 5.67).
| Outcome | Relative effect (95% CI) | Assumed risk - COXIBs | Corresponding risk - NSAIDs | Participants (studies) |
|---|---|---|---|---|
| Follow-up: mean 7–8 days | ||||
| Mean pain reduction from baseline (scale from 0 to 10) | - | Mean pain reduction from baseline was 1.79 | Mean pain reduction from baseline was 0.03 lower (0.19 lower to 0.13 higher) | 746 (4 studies) |
| Inflammation: swelling (Likert Scale from 0 to 3, 0 was best score) | - | Mean swelling in the control groups was 1.65 | Mean swelling was 0.13 higher (0.08 lower to 0.34 higher) | 735 (4 studies) |
| Global Assessment of treatment success (Likert Scale from 0 to 4, 0 was best score) | - | Mean Global Assessment of treatment success was 1.56 points | Mean Global Assessment of treatment success was 0.04 higher (0.12 lower to 0.2 higher) | 555 (3 studies) |
| Withdrawals due to adverse events | RR 2.4 (1.35 to 4.27) | 32 per 1000 | 77 per 1000 (43 to 137) | 974 (4 studies) |
| Total adverse events | RR 1.58 (1.38 to 1.81) | 382 per 1000 | 604 per 1000 (527 to 692) | 974 (4 studies) |
There was no statistically significant difference in pain, joint function, total number of adverse events, the number of serious adverse events, gastrointestinal, cardiovascular adverse events, or a combination of these between NSAIDs and oral glucocorticoids.
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