CDSR: Research on the treatment of tophi in patients with gout

Gout is the most common inflammatory arthritis in men.
In Western countries, at least 1% of the population will be affected by gout
.

Main results:

We included a trial in our initial evaluation
.

Due to the lack of blinding information from participants and experimenters, the performance and risk of detection bias in the two trials are unclear
.

Moderately certain evidence (downgraded due to imprecision; one study; 79 participants) showed: 1.
Pegloticase infusion every two weeks (biweekly) group Results: ①Compared with placebo group, 21/52 Two participants in the pegloticase treatment group could dissolve tophi, while the placebo group was 2/27, (risk ratio (RR) 5.
45, 95% confidence interval (CI) 1.
38-21.
54; compared with placebo group (41/43) )Compared; ②The proportion of subjects in the biweekly pegloticase treatment group (80/85) had similar adverse events (RR 0.
99, 95% CI 0.
91-1.
07).
③Compared
with the placebo group (1/43) Participants in the biweekly pegloticase treatment group (15/85) had a higher percentage of withdrawal due to adverse events (RR 7.

Moderately certain evidence (2 studies; 103 participants) showed that compared with placebo plus purinol group (16/50), Lesinurad 200 mg plus allopurinol group (11/53) had complete targeted tophi There is no clinically significant difference in regression (RR 0.
40, 95% CI 0.
04 to 4.
57); compared with the placebo + allopurinol group (16/50), the Lesinurad 400mg + allopurinol group (12/48) is clinically There was no significant difference in complete remission (RR 0.
79, 95% CI 0.
42 to 1.
49), while placebo group and placebo + allopurinol group (RR 0.
79, 95% CI 0.
42 to 1.
49) compared with the difference Not significant (RR 0.
40, 95% CI 0.
04 to 4.
57)
.

An extended experiment investigated the combination of lesinurad 200mg or 400mg with febuxostat or placebo (low certainty evidence, downgraded due to indirectness and imprecision)
.

Participants who did not take Lesinurad in the original study were randomized (CROSS) to take 200mg or 400mg, both of which were used in combination with febuxostat
.

Table 1 Comparison of tophi in the treatment of gout with Pegloticase every two weeks (biweekly) and placebo

Table 2 Comparison of the effects of Lesinurad 200 mg + allopurinol and placebo + allopurinol in the treatment of gout

Table 3 Comparison of the effects of Lesinurad 400mg + allopurinol and placebo + allopurinol in the treatment of gout

Table 4 Comparison of the effects of Lesinurad 400mg+febuxostat and Lesinurad 200mg+febuxostat in the treatment of gout

Conclusion: Moderately certain evidence suggests that pegloticase may be beneficial to the dissolution of tophi in gout
.

Sriranganathan MK, Vinik O, Pardo Pardo J,et al.
Interventions for tophi in gout.
Cochrane Database Syst Rev 2021 Aug 11;8