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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng219er4-lrg.png" alt="Cover of Evidence reviews for pharmacological and non-pharmacological interventions for managing gout flares" /></a></div><div class="bkr_bib"><h1 id="_NBK583527_"><span itemprop="name">Evidence reviews for pharmacological and non-pharmacological interventions for managing gout flares</span></h1><div class="subtitle">Gout: diagnosis and management</div><p><b>Evidence review D</b></p><p><i>NICE Guideline, No. 219</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Jun</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4603-7</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><div id="niceng219er4.s1"><h2 id="_niceng219er4_s1_">1. Pharmacological and non-pharmacological interventions for managing gout flares</h2><div id="niceng219er4.s1.1"><h3>1.1. Review question: What is the clinical and cost effectiveness of pharmacological interventions (including NSAIDs, colchicine, corticosteroids and IL-1 inhibitors) and non-pharmacological interventions for managing gout flares?</h3><div id="niceng219er4.s1.1.1"><h4>1.1.1. Introduction</h4><p>Recurrent flares are the most characteristic manifestation of gout and present with sudden onset of severe pain, swelling and inflammation, often overnight. Most flares present to and are managed in primary care.</p><p>Treatment of gout flares aims to provide rapid relief from joint pain and inflammation. The most commonly used pharmacological interventions to treat flares are non-steroidal anti-inflammatory drugs (NSAIDs), followed by colchicine and corticosteroids. However, many people with gout have contraindications to NSAIDs, such as peptic ulcer disease, chronic kidney disease and severe heart failure. Interleukin-1 inhibitors are a new approach to managing gout flares but are not commonly used in clinical practice. Non-pharmacological interventions such as rest and application of ice-packs to the affected joint are often employed as adjunctive treatment.</p><p>This evidence review will examine the clinical and cost effectiveness of pharmacological and non-pharmacological interventions to treat gout flares.</p></div><div id="niceng219er4.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng219er4.appa">Appendix A</a></p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab1"><a href="/books/NBK583527/table/niceng219er4.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab1" rid-ob="figobniceng219er4tab1"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab1/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab1"><a href="/books/NBK583527/table/niceng219er4.tab1/?report=objectonly" target="object" rid-ob="figobniceng219er4tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng219er4.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng219er4.appa">appendix A</a> and the <a href="/books/NBK583527/bin/methods-pdf-11132544061.pdf">methods</a> document</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng219er4.s1.1.4"><h4>1.1.4. Effectiveness evidence</h4><div id="niceng219er4.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>Eleven randomised controlled studies were included in the review<a class="bibr" href="#niceng219er4.s1.1.ref25" rid="niceng219er4.s1.1.ref25"><sup>25</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref32" rid="niceng219er4.s1.1.ref32"><sup>32</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref46" rid="niceng219er4.s1.1.ref46"><sup>46</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref53" rid="niceng219er4.s1.1.ref53"><sup>53</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref52" rid="niceng219er4.s1.1.ref52"><sup>52</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref51" rid="niceng219er4.s1.1.ref51"><sup>51</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref63" rid="niceng219er4.s1.1.ref63"><sup>63</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref69" rid="niceng219er4.s1.1.ref69"><sup>69</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref80" rid="niceng219er4.s1.1.ref80"><sup>80</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref47" rid="niceng219er4.s1.1.ref47"><sup>47</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref37" rid="niceng219er4.s1.1.ref37"><sup>37</sup></a> these are summarised in <a class="figpopup" href="/books/NBK583527/table/niceng219er4.tab2/?report=objectonly" target="object" rid-figpopup="figniceng219er4tab2" rid-ob="figobniceng219er4tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK583527/table/niceng219er4.tab3/?report=objectonly" target="object" rid-figpopup="figniceng219er4tab3" rid-ob="figobniceng219er4tab3">Table 3</a> - <a class="figpopup" href="/books/NBK583527/table/niceng219er4.tab7/?report=objectonly" target="object" rid-figpopup="figniceng219er4tab7" rid-ob="figobniceng219er4tab7">Table 7</a>).</p><p>The eleven randomised controlled studies evaluated pharmacological and non-pharmacological interventions for managing gout flares. One study evaluated the use of colchicine versus placebo. Four studies evaluated corticosteroids versus NSAIDs. Two studies compared NSAIDs versus colchicine. Three studies compared IL-1 inhibitors versus corticosteroids. One study compared ice therapy, corticosteroids and colchicine versus no ice therapy, corticosteroids and colchicine.</p><p>See also the study selection flow chart in <a href="#niceng219er4.appc">Appendix C</a>, study evidence tables in <a href="#niceng219er4.appd">Appendix D</a>, forest plots in <a href="#niceng219er4.appe">Appendix E</a> and GRADE tables in <a href="#niceng219er4.appf">Appendix F</a>.</p></div><div id="niceng219er4.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>Five Cochrane reviews were excluded.<a class="bibr" href="#niceng219er4.s1.1.ref24" rid="niceng219er4.s1.1.ref24"><sup>24</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref62" rid="niceng219er4.s1.1.ref62"><sup>62</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref73" rid="niceng219er4.s1.1.ref73"><sup>73</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref74" rid="niceng219er4.s1.1.ref74"><sup>74</sup></a><sup>,</sup><a class="bibr" href="#niceng219er4.s1.1.ref77" rid="niceng219er4.s1.1.ref77"><sup>77</sup></a> Janssens 2008<a class="bibr" href="#niceng219er4.s1.1.ref24" rid="niceng219er4.s1.1.ref24"><sup>24</sup></a> was excluded as two out of three included studies were not relevant, one of them had no pairwise analysis and another one included an inappropriate comparison (adrenocorticotropic hormone compared to triamcinolone). Sivera 2014<a class="bibr" href="#niceng219er4.s1.1.ref62" rid="niceng219er4.s1.1.ref62"><sup>62</sup></a> was excluded because one of the included studies had an inappropriate intervention (Rilonacept compared to indomethacin) and for other three studies outcomes were extracted at different time points (at 72 hours), whereas we used the last available timepoint across reviews. In this case the last available timepoint was 7 days. Van 2014<a class="bibr" href="#niceng219er4.s1.1.ref73" rid="niceng219er4.s1.1.ref73"><sup>73</sup></a> was excluded as only three out of twenty-three included studies were relevant. Studies were excluded due to inappropriate intervention, inappropriate comparison or they were not available. Van Echteld 2014<a class="bibr" href="#niceng219er4.s1.1.ref74" rid="niceng219er4.s1.1.ref74"><sup>74</sup></a> was excluded because one of two included studies used a very high dose of colchicine [6.7 mg] and common practice is 1 - 2 mg of Colchicine per day. Therefore, this study (Ahern 1987)<a class="bibr" href="#niceng219er4.s1.1.ref1" rid="niceng219er4.s1.1.ref1"><sup>1</sup></a> was excluded from our review. The other study (Terkeltaub 2010)<a class="bibr" href="#niceng219er4.s1.1.ref69" rid="niceng219er4.s1.1.ref69"><sup>69</sup></a> included high dose colchicine and low dose colchicine. We analysed the low dose and removed the high dose data. Wechalekar 2013<a class="bibr" href="#niceng219er4.s1.1.ref77" rid="niceng219er4.s1.1.ref77"><sup>77</sup></a> was excluded because this review had no included studies. All included studies in all five Cochrane reviews were checked for inclusion and 6 of them were included in our review</p><p>See the excluded studies list in <a href="#niceng219er4.appj">Appendix J</a>.</p></div></div><div id="niceng219er4.s1.1.5"><h4>1.1.5. Summary of studies included in the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab2"><a href="/books/NBK583527/table/niceng219er4.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab2" rid-ob="figobniceng219er4tab2"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab2/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab2"><a href="/books/NBK583527/table/niceng219er4.tab2/?report=objectonly" target="object" rid-ob="figobniceng219er4tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng219er4.appd">Appendix D</a> for full evidence tables.</p></div><div id="niceng219er4.s1.1.6"><h4>1.1.6. Summary of the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab3"><a href="/books/NBK583527/table/niceng219er4.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab3" rid-ob="figobniceng219er4tab3"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab3/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: Colchicine versus placebo." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab3"><a href="/books/NBK583527/table/niceng219er4.tab3/?report=objectonly" target="object" rid-ob="figobniceng219er4tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Colchicine versus placebo. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab4"><a href="/books/NBK583527/table/niceng219er4.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab4" rid-ob="figobniceng219er4tab4"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab4/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: Corticosteroids versus NSAIDs." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab4"><a href="/books/NBK583527/table/niceng219er4.tab4/?report=objectonly" target="object" rid-ob="figobniceng219er4tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Corticosteroids versus NSAIDs. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab5"><a href="/books/NBK583527/table/niceng219er4.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab5" rid-ob="figobniceng219er4tab5"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab5/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: NSAIDs versus colchicine." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab5"><a href="/books/NBK583527/table/niceng219er4.tab5/?report=objectonly" target="object" rid-ob="figobniceng219er4tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: NSAIDs versus colchicine. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab6"><a href="/books/NBK583527/table/niceng219er4.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab6" rid-ob="figobniceng219er4tab6"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab6/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: IL-1 inhibitors versus corticosteroids." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab6"><a href="/books/NBK583527/table/niceng219er4.tab6/?report=objectonly" target="object" rid-ob="figobniceng219er4tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: IL-1 inhibitors versus corticosteroids. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab7"><a href="/books/NBK583527/table/niceng219er4.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab7" rid-ob="figobniceng219er4tab7"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab7/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab7/?report=previmg" alt="Table 7. Clinical evidence summary: ice plus prednisone and colchicine versus prednisone and colchicine." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab7"><a href="/books/NBK583527/table/niceng219er4.tab7/?report=objectonly" target="object" rid-ob="figobniceng219er4tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: ice plus prednisone and colchicine versus prednisone and colchicine. </p></div></div><p>See <a href="#niceng219er4.appf">Appendix F</a> for full GRADE tables</p></div><div id="niceng219er4.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng219er4.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>One health economic study comparing naproxen and low-dose colchicine was included in this review<a class="bibr" href="#niceng219er4.s1.1.ref47" rid="niceng219er4.s1.1.ref47"><sup>47</sup></a>. This is summarised in the health economic evidence profile below (<a class="figpopup" href="/books/NBK583527/table/niceng219er4.tab8/?report=objectonly" target="object" rid-figpopup="figniceng219er4tab8" rid-ob="figobniceng219er4tab8">Table 8</a>) and the health economic evidence table.</p><p>No additional health economic analyses comparing the other relevant comparisons listed in the protocol were identified for this review.</p></div><div id="niceng219er4.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the <a href="#niceng219er4.appj.s2">health economic study</a> selection flow chart.</p></div></div><div id="niceng219er4.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab8"><a href="/books/NBK583527/table/niceng219er4.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab8" rid-ob="figobniceng219er4tab8"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab8/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab8/?report=previmg" alt="Table 8. Health economic evidence profile: naproxen versus low-dose colchicine." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab8"><a href="/books/NBK583527/table/niceng219er4.tab8/?report=objectonly" target="object" rid-ob="figobniceng219er4tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Health economic evidence profile: naproxen versus low-dose colchicine. </p></div></div></div><div id="niceng219er4.s1.1.9"><h4>1.1.9. Economic model</h4><p>This area was not prioritised for new cost-effectiveness analysis.</p></div><div id="niceng219er4.s1.1.10"><h4>1.1.10. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab9"><a href="/books/NBK583527/table/niceng219er4.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab9" rid-ob="figobniceng219er4tab9"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab9/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab9/?report=previmg" alt="Table 9. UK cost of NSAIDs for people without CKD." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab9"><a href="/books/NBK583527/table/niceng219er4.tab9/?report=objectonly" target="object" rid-ob="figobniceng219er4tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">UK cost of NSAIDs for people without CKD. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab10"><a href="/books/NBK583527/table/niceng219er4.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab10" rid-ob="figobniceng219er4tab10"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab10/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab10/?report=previmg" alt="Table 10. UK cost of NSAIDs for people with CKD stage 3." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab10"><a href="/books/NBK583527/table/niceng219er4.tab10/?report=objectonly" target="object" rid-ob="figobniceng219er4tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">UK cost of NSAIDs for people with CKD stage 3. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab11"><a href="/books/NBK583527/table/niceng219er4.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab11" rid-ob="figobniceng219er4tab11"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab11/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab11/?report=previmg" alt="Table 11. UK cost of NSAIDs for people with CKD stage 4-5." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab11"><a href="/books/NBK583527/table/niceng219er4.tab11/?report=objectonly" target="object" rid-ob="figobniceng219er4tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">UK cost of NSAIDs for people with CKD stage 4-5. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab12"><a href="/books/NBK583527/table/niceng219er4.tab12/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab12" rid-ob="figobniceng219er4tab12"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab12/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab12/?report=previmg" alt="Table 12. UK cost of Colchicine." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab12"><a href="/books/NBK583527/table/niceng219er4.tab12/?report=objectonly" target="object" rid-ob="figobniceng219er4tab12">Table 12</a></h4><p class="float-caption no_bottom_margin">UK cost of Colchicine. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab13"><a href="/books/NBK583527/table/niceng219er4.tab13/?report=objectonly" target="object" title="Table 13" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab13" rid-ob="figobniceng219er4tab13"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab13/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab13/?report=previmg" alt="Table 13. UK cost of Corticosteroids." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab13"><a href="/books/NBK583527/table/niceng219er4.tab13/?report=objectonly" target="object" rid-ob="figobniceng219er4tab13">Table 13</a></h4><p class="float-caption no_bottom_margin">UK cost of Corticosteroids. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab14"><a href="/books/NBK583527/table/niceng219er4.tab14/?report=objectonly" target="object" title="Table 14" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab14" rid-ob="figobniceng219er4tab14"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab14/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab14/?report=previmg" alt="Table 14. UK cost of proton pump inhibitors (PPI’s)." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab14"><a href="/books/NBK583527/table/niceng219er4.tab14/?report=objectonly" target="object" rid-ob="figobniceng219er4tab14">Table 14</a></h4><p class="float-caption no_bottom_margin">UK cost of proton pump inhibitors (PPI’s). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er4tab15"><a href="/books/NBK583527/table/niceng219er4.tab15/?report=objectonly" target="object" title="Table 15" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er4tab15" rid-ob="figobniceng219er4tab15"><img class="small-thumb" src="/books/NBK583527/table/niceng219er4.tab15/?report=thumb" src-large="/books/NBK583527/table/niceng219er4.tab15/?report=previmg" alt="Table 15. UK cost of IL-1 Inhibitors." /></a><div class="icnblk_cntnt"><h4 id="niceng219er4.tab15"><a href="/books/NBK583527/table/niceng219er4.tab15/?report=objectonly" target="object" rid-ob="figobniceng219er4tab15">Table 15</a></h4><p class="float-caption no_bottom_margin">UK cost of IL-1 Inhibitors. </p></div></div></div><div id="niceng219er4.s1.1.11"><h4>1.1.11. Evidence statements</h4><div id="niceng219er4.s1.1.11.1"><h5>Economic</h5><ul><li class="half_rhythm"><div>One cost-utility analysis found that naproxen was cost effective compared to low-dose colchicine for the treatment of gout flares. Naproxen was the dominant strategy (less costly and more effective). This analysis was assessed as partially applicable with minor limitations.</div></li></ul></div></div><div id="niceng219er4.s1.1.12"><h4>1.1.12. The committee’s discussion and interpretation of the evidence</h4><div id="niceng219er4.s1.1.12.1"><h5>1.1.12.1. The outcomes that matter most</h5><p>The committee considered the following outcomes as important for decision-making: health-related quality of life, pain, joint swelling/joint inflammation, joint tenderness, patient global assessment of treatment success, adverse events (cardiovascular, renal and gastrointestinal), admission (hospital and A&E/urgent care) and GP visits.</p><p>The committee decided to combine joint swelling and joint inflammation as they agreed that these outcomes are synonymous for people with gout. The committee also agreed to categorise timepoints reported in the included studies by short-term (up to two weeks), medium-term (two to six weeks) and long-term (more than six weeks).</p></div><div id="niceng219er4.s1.1.12.2"><h5>1.1.12.2. The quality of the evidence</h5><p>Eleven randomised controlled trials (RCTs) evaluating pharmacological therapy and one randomised controlled trial (RCT) evaluating combination therapy (pharmacological and non-pharmacological interventions) for managing gout flares were included in this review.</p><p>One RCT evaluated the use of colchicine versus placebo. The evidence was limited as only two outcomes were reported by the study. The outcome data was only available for pain (proportion of joints with 50% or greater decrease in pain score (on VAS) from baseline) and gastrointestinal adverse events (diarrhoea and vomiting). Both were reported as short-term outcomes (up to 2 weeks). The quality of pain (proportion of joints with 50% or greater decrease in pain score (on VAS) from baseline) outcome was graded as moderate due to high risk of selection bias. The quality of the gastrointestinal adverse events outcome was graded very low due to high risk of selection bias and imprecision.</p><p>Four studies evaluated the use of corticosteroids versus NSAIDs. The outcome data was reported for pain (VAS, number of patients with clinically significant change in pain score at rest and number of patients with clinically significant change in pain score with activity), joint tenderness, adverse events (gastrointestinal and cardiovascular), number of patients visited ED, number of patients visited outpatient department and GP visits. All outcomes were reported as short-term (up to 2 weeks). The quality of evidence ranged from high to low quality due to lack of blinding, imprecision and inconsistency.</p><p>Two studies compared NSAIDs versus colchicine. The outcome data was reported for pain (change score), complete pain resolution, joint swelling scores, patient assessment of global treatment response (completely/much better), adverse events (gastrointestinal), number of patients visited ED and GP visits. Outcomes were reported as short term (up to 2 weeks) and medium-term (2 to 6 weeks). The quality of evidence ranged from high to very low quality due to lack of blinding, attrition bias and imprecision.</p><p>Three studies compared IL-1 inhibitors versus corticosteroids. The outcome data was reported for health-related quality of life SF 36 (physical and mental components), pain (VAS and VAS % change), joint swelling, joint tenderness, patient global assessment (OR), patient global assessment (good or excellent) and adverse events (any). Outcomes were reported as short term (up to 2 weeks) and long-term (more than 6 weeks). The quality of evidence ranged from moderate to very low quality due selection bias, lack of blinding and imprecision.</p><p>One study compared ice therapy plus corticosteroids and colchicine versus no ice therapy plus corticosteroids and colchicine. The outcome data was only reported for pain (VAS) and joint circumference (joint swelling). Both outcomes were reported as short-term (up to 2 weeks). The quality of evidence ranged from low to very low quality due to selection bias, lack of blinding and imprecision.</p></div><div id="niceng219er4.s1.1.12.3"><h5>1.1.12.3. Benefits and harms</h5><p>The evidence showed a clinical benefit for colchicine when compared with placebo for reducing pain (50% or greater decrease in pain scores from baseline), however the evidence indicated clinical harm for gastrointestinal adverse events (diarrhoea and vomiting) in the colchicine group in the short-term (up to 2 weeks).</p><p>The evidence showed a clinical benefit for corticosteroids when compared to NSAIDs for short-term (up to 2 weeks) gastrointestinal adverse events (abdominal pain, indigestion, nausea, vomiting, diarrhoea and GI haemorrhage). The evidence suggested that there was no clinically important difference for pain, joint tenderness, cardiovascular adverse events, number of patients who visited emergency and outpatient departments, and G.P. visits.</p><p>The evidence showed a clinical benefit for NSAIDs when compared to colchicine for short-term (up to 2 weeks) gastrointestinal adverse events (nausea and or vomiting, diarrhoea and constipation). There was no difference for abdominal pain, dyspepsia or vomiting at 2 weeks or any of these outcomes in the medium-term (2 to 6 weeks). The evidence suggested that there was no clinically important difference for pain outcomes (change score, complete pain resolution at short-term (up to 2 weeks) and medium term (2 to 6 weeks), joint swelling scores, patient assessment of global treatment response (completely/much better at short-term (up to 2 weeks) and medium-term (2 to 6 weeks)), number of patients visiting ED (medium-term 2 to 6 weeks) and number of GP visits (medium-term 2 to 6 weeks).</p><p>The evidence showed a clinical benefit for IL-1 inhibitors compared to corticosteroids for health related quality of life outcomes: SF36 physical component at short term (up to 2 weeks) and long-term (more than 6 weeks), SF-36 mental component long-term (more than 6 weeks), pain outcomes (VAS and VAS % change both short-term up to 2 weeks) and participant global assessment of response to treatment (good or excellent short up to 2 weeks). The evidence showed clinical benefit for corticosteroids compared to IL-1 inhibitors for any adverse events in the short-term. For joint swelling, joint tenderness and patient global assessment outcomes absolute effects and clinical significance could not be estimated as studies only reported odds ratios and did not report means separately for intervention and control arms, but the results favoured corticosteroids.</p><p>The evidence showed a clinical benefit for combination therapy ice and corticosteroid and colchicine compared with no ice therapy and corticosteroid and colchicine for pain (VAS). The evidence suggested no clinical difference for joint circumference (joint swelling).</p><div id="niceng219er4.s1.1.12.3.1"><h5>Treatment options for managing gout flares</h5><p>Overall, the evidence showed no clinical difference for NSAIDs compared to colchicine and corticosteroids for most of the outcomes. There was some evidence of benefit for colchicine when compared to placebo for pain outcome. However, there was also evidence of harm for colchicine when comparing both to placebo and NSAIDs for gastrointestinal adverse events. The evidence also suggested that there is clinical benefit for corticosteroids when compared to NSAIDs for gastrointestinal adverse events. The committee discussed that in current practice NSAIDs, or colchicine would usually be prescribed first before using corticosteroids. The committee discussed when considering treatments for older patients, colchicine would not be the first choice because of risk of side effects, and when prescribing corticosteroids, the lowest dose would be used. The committee also noted NSAIDs are potentially nephrotoxic, with renal adverse effects including AKI, renal disease progression and hyperkalaemia. The risks are highest in those with more advanced CKD and are increased in older people and those taking inhibitors of the RAS and diuretics. They agreed NSAIDS would be prescribed taking into account patient characteristics, the CKD stage and duration of therapy.</p><p>After reviewing the evidence, the committee agreed that the evidence was not strong for any of the drugs and concluded recommendations should reflect current practice of considering either NSAIDs, colchicine or a corticosteroid based on the presence of any comorbidities, other medications being taken and the preference of the patient.</p><p>Based on their experience the committee decided to recommend considering co-prescribing proton pump inhibitor (PPI) for people taking an NSAID for a flare. They acknowledged PPI are not always prescribed if NSAIDS were only to be taken for a short period of time.</p><p>The committee noted intra-articular and intra-muscular corticosteroids are more commonly used to manage gout flare in secondary care than in GP practices, Oral corticosteroid can be given as a first-line option but corticosteroid by injection could be considered.</p><p>IL-1 inhibitors showed clinical benefit when compared to corticosteroids for the vast majority of outcomes, however the committee agreed the cost of IL1-inhibitors is high and there are effective alternative drugs available and therefore this drug would not usually be considered for the vast majority of people with a flare. The committee noted this treatment is used in very few centres in the UK and would only be considered appropriate for a very small population such as people with contraindications or non-response to all NSAIDS, colchicine and corticosteroids. Therefore, the committee decided to make a “do not offer” recommendation for IL-1 inhibitors unless the other drugs had been tried or were contraindicated or not tolerated.</p><p>The evidence showed clinical benefit for ice therapy compared to no ice therapy for pain (VAS) outcome. The committee considered evidence from only one small study to be limited, however in their experience applying ice can help to ease pain and inflammation and it is a simple and inexpensive treatment people can try. Therefore, the committee decided to recommend ice therapy as an adjunct to pharmacological treatments.</p></div></div><div id="niceng219er4.s1.1.12.4"><h5>1.1.12.4. Cost effectiveness and resource use</h5><p>One economic evaluation was identified for this review. The included health economic study compared naproxen to low-dose colchicine, illustrating that naproxen was the dominant strategy (less costly and more effective). In addition, naproxen had an 80% chance of being cost effective at NICE’s £20,000 threshold. The included health economic evidence only evaluated the cost effectiveness of naproxen and low dose colchicine and did not include other drugs relevant to this review question (NSAIDs other than naproxen, corticosteroids and IL-1 inhibitors), therefore unit costs were also presented to aid committee consideration of cost effectiveness.</p><p>The committee discussed the limitations of the included health economic study, noting that the cost of PPIs were not included for the total costs of naproxen. Although, the committee noted the cost of PPIs are relatively cheap, costing £0.06 – £0.98 per unit. The committee also acknowledged that PPIs may not be prescribed to all patients receiving NSAIDs if the duration of treatment is short and not anticipated to be long-term. For example, PPIs may not be required if a person is only anticipated to receive NSAIDs for the treatment of gout flares and they are only expected to experience one or two gout flares per year (where flares last for an average duration of four to five days)..</p><p>Considering the costs of PPIs and the costs presented in the included health economic study, the committee concluded the overall results of the cost effectiveness analysis would unlikely be changed if the costs of PPIs had been included in the analysis. The total costs for naproxen and colchicine presented in the health economic study were £17.57 and £23.31 respectively. In the analysis, naproxen was prescribed for a total of seven days, therefore assuming a cost of £0.06 - £0.98 per day for the cost of a PPI, the total cost for naproxen would increase by £0.42 - £6.86 – resulting in a total cost of £17.99 - £24.43. Although £24.43 is more expensive than the total cost of colchicine (£23.31). The committee noted that the range for the cost of PPIs was predominately driven by the cost of Omeprazole 40mg, costing £0.98. Excluding the cost of Omeprazole 40mg, the cost of PPIs ranges from £0.06 - £0.49. When PPIs cost a maximum £0.49 the total cost for naproxen is £19.74 which is cheaper than the total cost of colchicine (£23.31).</p><p>The committee noted the use of PPIs would not affect the effectiveness of NSAIDs and so naproxen would still be the dominant strategy (less costly and more effective) when all PPIs, except Omeprazole 40mg, are prescribed. When Omeprazole 40mg is prescribed, naproxen is more costly and more effective and the ICER is £2,800 per QALY gained. However, in general, the committee did note that the time horizon of the analysis (4 weeks) was not sufficiently long enough to capture the long-term adverse events for not prescribing a PPI.</p><p>Overall although the included health economic study illustrated that naproxen was the dominant strategy compared to low dose colchicine, due to potential limitations of this study and committee opinion, the committee made an ‘offer’ recommendation for; NSAIDs, low dose colchicine, and prednisolone as a first-line treatment for a gout flare. The committee noted that when prescribing therapeutic treatment for a gout flare – in the form of NSAIDs, low dose colchicine and oral prednisolone – it is important to take account of patient comorbidities, co-prescribing and patient preferences. The committee also considered the costs of NSAIDs, low dose colchicine, and prednisolone and concluded that all interventions would be cost effective at NICE’s £20,000 threshold, whereby the most cost-effective intervention would be patient specific. For example, in people where NSAIDs or low dose colchicine are contraindicated or not tolerated, oral prednisolone would be the most cost-effective drug for managing gout flares. This recommendation is not expected to result in a substantial resource impact as the recommendation is reflective of current practice in England.</p><p>The committee discussed that in instances where NSAIDs, low dose colchicine or oral prednisolone are contraindicated, not tolerated or not effective, intra-articular or intra-muscular corticosteroid injection may also be appropriate. The committee acknowledged that, if clinically appropriate, oral prednisolone should be prescribed as a first-line corticosteroid because oral prednisolone is cheaper than intra-articular or intra-muscular corticosteroid injections. Oral prednisolone costs £0.18 per day and is typically prescribed for five days, costing £0.90. Intra-articular or intra-muscular injections cost £1.49 - £12.00 per injection but will also have additional costs in terms of nurse administration time. Overall, the committee made a ‘consider’ recommendation for the use of, intra-articular or intra-muscular corticosteroid injections. This recommendation is not expected to have a substantial resource impact as it is reflective of current practice.</p><p>The committee also discussed the use of IL-1 inhibitors, noting that less than 1% of gout patients would be prescribed an IL-1 inhibitor for treatment of a gout flare. Clinical evidence was presented comparing canakinumab and intramuscular corticosteroids (triamcinolone). However, the cost of canakinumab is much greater than triamcinolone (£9,927 and £0.89 - £12.00 per injection respectively) therefore the committee concluded it was highly unlikely Canakinumab would be an effective use of NHS resources.</p><p>The committee also discussed the use of anakinra, which is the additional IL-1 inhibitor included in the clinical protocol. No clinical evidence was presented for anakinra, but the committee noted Anakinra is substantially cheaper than canakinumab. Anakinra costs £26.23 per unit and typically three to five doses of anakinra will be given to people for management of a gout flare, costing £78.69 - £131.15. Conversely, canakinumab costs £9,928 per unit, with one injection given for the treatment of a gout flare.</p><p>Overall, IL-1 inhibitors are substantially more expensive than NSAIDs, low dose colchicine, and corticosteroids. Therefore, the committee made a ‘do not offer’ recommendation for the use of IL-1 inhibitors. The committee did however acknowledge that in clinical practice IL-1 inhibitors are sometimes prescribed for patients with the most severe gout where all other treatment options have failed, noting people should be referred to rheumatology services before prescribing an IL-1 inhibitor. Based on clinical experience, the committee concluded that IL-1 inhibitors could be cost effective for patients where NSAIDs, low dose colchicine, and corticosteroids are contraindicated or not tolerated because gout flares can be extremely painful. This recommendation is not expected to have a substantial resource impact as it is reflective of current practice.</p><p>Non-pharmacological interventions for managing gout flares are typically recommended in conjunction with pharmacological interventions. The cost of ice is borne by patients themselves and so will not have a substantial resource impact.</p></div></div><div id="niceng219er4.s1.1.13"><h4>1.1.13. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.3.1 to 1.3.5 and the research recommendation on the clinical and cost effectiveness of colchicine compared with corticosteroids for managing gout flares?</p></div><div id="niceng219er4.s1.1.rl.r1"><h4>1.1.14. References</h4><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref1">Ahern
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H. Canakinumab reduces the risk of acute gouty arthritis flares during initiation of allopurinol treatment: Results of a double-blind, randomised study - Commentary. International Journal of Advances in Rheumatology. 2011; 9(4):150</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref21">Huizinga
|
|
T, Nigrovic
|
|
P, Ruderman
|
|
E, Schulze-Koops
|
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H. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Commentary. International Journal of Advances in Rheumatology. 2010; 8(3):120 [<a href="https://pubmed.ncbi.nlm.nih.gov/20131255" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20131255</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref22">Janssen
|
|
CA, Oude Voshaar
|
|
MAH, Ten Klooster
|
|
PM, Vonkeman
|
|
HE, van de Laar
|
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M. Development and validation of a patient-reported gout attack intensity score for use in gout clinical studies. Rheumatology. 2019; 58(11):1928–1934 [<a href="/pmc/articles/PMC6812713/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6812713</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30859221" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30859221</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref23">Janssen
|
|
CA, Oude Voshaar
|
|
MAH, Vonkeman
|
|
HE, Jansen
|
|
TLTA, Janssen
|
|
M, Kok
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MR
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et al. Anakinra for the treatment of acute gout flares: A randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019; 58(8):1344–1352 [<a href="https://pubmed.ncbi.nlm.nih.gov/30602035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30602035</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref24">Janssens
|
|
H, Lucassen
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|
P, Van
|
|
dLF, Janssen
|
|
M, Van
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dLE. Systemic corticosteroids for acute gout. Cochrane Database of Systematic Reviews
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2008, Issue 2. Art. No.: CD005521. DOI: 10.1002/14651858.CD005521.pub2. [<a href="/pmc/articles/PMC8276233/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8276233</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18425920" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18425920</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD005521.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref25">Janssens
|
|
HJ, Janssen
|
|
M, van de Lisdonk
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EH, van Riel
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PL, van Weel
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C. Use of oral prednisolone or naproxen for the treatment of gout arthritis: a double-blind, randomised equivalence trial. Lancet. 2008; 371(9627):1854–1860 [<a href="https://pubmed.ncbi.nlm.nih.gov/18514729" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18514729</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref26">Janssens
|
|
HJEM, Janssen
|
|
M, Van De Lisdonk
|
|
EH, Van Riel
|
|
PLCM, Van Weel
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C. [Prednisolone, a suitable first-choice treatment for gout pain: a randomized, double-blind, equivalent trial with naproxen as reference]. Nederlands Tijdschrift voor Geneeskunde. 2009; 153(23):1108–1116</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref27">Jomori
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T, Saitoh
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K, Hosoya
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T. Effects of topiroxostat on the serum urate levels and urinary albumin excretion in concomitant therapy or in primary disease of chronic kidney disease: -A post hoc analysis of multicenter, randomized, placebo-controlled, double-blind study in hyperuricemic stage 3 chronic kidney disease patients with or without gout. Japanese pharmacology and therapeutics. 2015; 43(1):39–50</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref28">Khanna
|
|
PP, Gladue
|
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HS, Singh
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MK, FitzGerald
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JD, Bae
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S, Prakash
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S
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et al. Treatment of acute gout: a systematic review. Seminars in Arthritis and Rheumatism. 2014; 44(1):31–38 [<a href="https://pubmed.ncbi.nlm.nih.gov/24650777" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24650777</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref29">Lederman
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R. A double-blind comparison of Etodolac (Lodine) and high doses of naproxen in the treatment of acute gout. Advances in Therapy. 1990; 7(6):344–354</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref30">Li
|
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T, Chen
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SL, Dai
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Q, Han
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XH, Li
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ZG, Wu
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DH
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et al. Etoricoxib versus indometacin in the treatment of Chinese patients with acute gouty arthritis: a randomized double-blind trial. Chinese Medical Journal. 2013; 126(10):1867–1871 [<a href="https://pubmed.ncbi.nlm.nih.gov/23673101" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23673101</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref31">Lin
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TM, Chi
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JE, Chang
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CC, Kang
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YN. Do etoricoxib and indometacin have similar effects and safety for gouty arthritis? A meta-analysis of randomized controlled trials. Journal of Pain Research. 2019; 12:83–91 [<a href="/pmc/articles/PMC6305166/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6305166</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30588082" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30588082</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref32">Liu
|
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P, Chen
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Y, Wang
|
|
B, Wang
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Z, Li
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C, Wang
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Y. Expression of microRNAs in the plasma of patients with acute gouty arthritis and the effects of colchicine and etoricoxib on the differential expression of microRNAs. Archives of Medical Science. 2019; 15(4):1047–1055 [<a href="/pmc/articles/PMC6657241/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6657241</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31360199" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31360199</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref33">Liu
|
|
X, Sun
|
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D, Ma
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X, Li
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C, Ying
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J, Yan
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Y. Benefit-risk of corticosteroids in acute gout patients: An updated meta-analysis and economic evaluation. Steroids. 2017; 128:89–94 [<a href="https://pubmed.ncbi.nlm.nih.gov/28899726" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28899726</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref34">Liu
|
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Y, Li
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ZC, Chen
|
|
JB, Yu
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TT, Cui
|
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C, Zhang
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HB. [Therapeutic efficacy of small doses of colchicine combined with glucocorticoid for acute gouty arthritis]. Medical journal of chinese people’s liberation army. 2015; 40(8):652–655</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref35">Lundberg
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GD. Prednisolone and naproxen both work for pain relief in acute gout. Medscape Journal of Medicine. 2008; 10(9):207 [<a href="/pmc/articles/PMC2580083/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2580083</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19008969" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19008969</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref36">Maccagno
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A, Di Giorgio
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E, Romanowicz
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A. Effectiveness of etodolac (‘Lodine’) compared with naproxen in patients with acute gout. Current Medical Research and Opinion. 1991; 12(7):423–429 [<a href="https://pubmed.ncbi.nlm.nih.gov/1838075" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1838075</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref37">Man
|
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CY, Cheung
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IT, Cameron
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PA, Rainer
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TH. Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial. Annals of Emergency Medicine. 2007; 49(5):670–677 [<a href="/pmc/articles/PMC7115288/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7115288</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17276548" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17276548</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref38">Martina
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SD, Vesta
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KS, Ripley
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TL. Etoricoxib: a highly selective COX-2 inhibitor. Annals of Pharmacotherapy. 2005; 39(5):854–862 [<a href="https://pubmed.ncbi.nlm.nih.gov/15827069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15827069</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref39">Moon
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KT. Low-dose colchicine effective for acute gout flare-ups. American Family Physician. 2011; 83(3):316</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref40">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref41">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated October
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2020]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref42">Navarra
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S, Rubin
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BR, Yu
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Q, Smugar
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SS, Tershakovec
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AM. Association of baseline disease and patient characteristics with response to etoricoxib and indomethacin for acute gout. Current Medical Research and Opinion. 2007; 23(7):1685–1691 [<a href="https://pubmed.ncbi.nlm.nih.gov/17588299" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17588299</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref43">NHS Business Services Authority. NHS electronic drug tariff: October 2020. 2020. Available from: <a href="http://www.nhsbsa.nhs.uk/PrescriptionServices/4940.aspx" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nhsbsa.nhs<wbr style="display:inline-block"></wbr>​.uk/PrescriptionServices/4940.aspx</a> Last accessed: 30/10/2021.</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref44">Parperis
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K. Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care. Annals of the Rheumatic Diseases. 2019; Epub [<a href="https://pubmed.ncbi.nlm.nih.gov/31776116" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31776116</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref45">Perez-Ruiz
|
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F, Calabozo
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M, Fernandez-Lopez
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MJ, Herrero-Beites
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A, Ruiz-Lucea
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E, Garcia-Erauskin
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et al. Treatment of chronic gout in patients with renal function impairment: an open, randomized, actively controlled study. JCR: Journal of Clinical Rheumatology. 1999; 5(2):49–55 [<a href="https://pubmed.ncbi.nlm.nih.gov/19078356" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19078356</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref46">Rainer
|
|
TH, Cheng
|
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CH, Janssens
|
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HJ, Man
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CY, Tam
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LS, Choi
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YF
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et al. Oral prednisolone in the treatment of acute gout: A pragmatic, multicenter, double-blind, randomized trial. Annals of Internal Medicine. 2016; 164(7):464–471 [<a href="https://pubmed.ncbi.nlm.nih.gov/26903390" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26903390</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref47">Roddy
|
|
E, Clarkson
|
|
K, Blagojevic-Bucknall
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M, Mehta
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R, Oppong
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R, Avery
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E, Mallen
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CD. Naproxen or low-dose colchicine for gout flares in primary care? Response to: ‘Open-label randomised pragmatic trial (CONTACT) comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care’ by Parperis et al. Annals of the Rheumatic Diseases. 2019; [<a href="https://pubmed.ncbi.nlm.nih.gov/31801739" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31801739</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref49">Rubin
|
|
BR, Burton
|
|
R, Navarra
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S, Antigua
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J, Londono
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J, Pryhuber
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KG
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|
|
KG, Khanna
|
|
PP, Keenan
|
|
RT, Ohlman
|
|
S, Osterling Koskinen
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L, Sparve
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et al. A randomized, phase 2 study evaluating the efficacy and safety of anakinra in the treatment of gout flares. Arthritis & Rheumatology. 2021; 73(8):1533–1542 [<a href="https://pubmed.ncbi.nlm.nih.gov/33605029" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33605029</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref51">Schlesinger
|
|
N, Alten
|
|
RE, Bardin
|
|
T, Schumacher
|
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HR, Bloch
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M, Gimona
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A
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et al. Canakinumab for acute gouty arthritis in patients with limited treatment options: results from two randomised, multicentre, active-controlled, double-blind trials and their initial extensions. Annals of the Rheumatic Diseases. 2012; 71(11):1839–1848 [<a href="https://pubmed.ncbi.nlm.nih.gov/22586173" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22586173</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref52">Schlesinger
|
|
N, De Meulemeester
|
|
M, Pikhlak
|
|
A, Yucel
|
|
AE, Richard
|
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D, Murphy
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V
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|
|
N, Detry
|
|
MA, Holland
|
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BK, Baker
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DG, Beutler
|
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AM, Rull
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M
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|
|
N, Mysler
|
|
E, Lin
|
|
HY, De Meulemeester
|
|
M, Rovensky
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J, Arulmani
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U
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et al. Canakinumab reduces the risk of acute gouty arthritis flares during initiation of allopurinol treatment: results of a double-blind, randomised study. Annals of the Rheumatic Diseases. 2011; 70(7):1264–1271 [<a href="/pmc/articles/PMC3103669/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3103669</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21540198" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21540198</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref55">Schlesinger
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|
N, Norquist
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JM, Watson
|
|
DJ. Serum urate during acute gout. Journal of Rheumatology. 2009; 36(6):1287–1289 [<a href="https://pubmed.ncbi.nlm.nih.gov/19369457" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19369457</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref56">Schumacher
|
|
HR, Berger
|
|
MF, Li-Yu
|
|
J, Perez-Ruiz
|
|
F, Burgos-Vargas
|
|
R, Li
|
|
C. Efficacy and tolerability of celecoxib in the treatment of acute gouty arthritis: a randomized controlled trial. Journal of Rheumatology. 2012; 39(9):1859–1866 [<a href="https://pubmed.ncbi.nlm.nih.gov/22859357" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22859357</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref57">Schumacher
|
|
HR, Jr., Boice
|
|
JA, Daikh
|
|
DI, Mukhopadhyay
|
|
S, Malmstrom
|
|
K, Ng
|
|
J
|
|
et al. Randomised double blind trial of etoricoxib and indometacin in treatment of acute gouty arthritis. BMJ. 2002; 324(7352):1488–1492 [<a href="/pmc/articles/PMC116444/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC116444</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12077033" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12077033</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref58">Seth
|
|
R, Kydd
|
|
AS, Falzon
|
|
L, Bombardier
|
|
C, van der Heijde
|
|
DM, Edwards
|
|
CJ. Preventing attacks of acute gout when introducing urate-lowering therapy: a systematic literature review. Journal of Rheumatology - Supplement. 2014; 92:42–47 [<a href="https://pubmed.ncbi.nlm.nih.gov/25180127" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25180127</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref59">Sharma
|
|
E, Pedersen
|
|
B, Terkeltaub
|
|
R. Patients prescribed anakinra for acute gout have baseline increased burden of hyperuricemia, tophi, and comorbidities, and ultimate all-cause mortality. Clinical medicine insights Arthritis and musculoskeletal disorders. 2019; 12:1179544119890853 [<a href="/pmc/articles/PMC6902385/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6902385</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31839715" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31839715</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref60">Shekelle
|
|
PG, Newberry
|
|
SJ, FitzGerald
|
|
JD, Motala
|
|
A, O’Hanlon
|
|
CE, Tariq
|
|
A
|
|
et al. Management of gout: A systematic review in support of an American college of physicians clinical practice guideline. Annals of Internal Medicine. 2017; 166(1):37–51 [<a href="https://pubmed.ncbi.nlm.nih.gov/27802478" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27802478</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref61">Shrestha
|
|
M, Morgan
|
|
DL, Moreden
|
|
JM, Singh
|
|
R, Nelson
|
|
M, Hayes
|
|
JE. Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis. Annals of Emergency Medicine. 1995; 26(6):682–686 [<a href="https://pubmed.ncbi.nlm.nih.gov/7492036" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7492036</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref62">Sivera
|
|
F, Wechalekar
|
|
M, Andrés
|
|
M, Buchbinder
|
|
R, Carmona
|
|
L. Interleukin-1 inhibitors for acute gout. Cochrane Database of Systematic Reviews
|
|
2014, Issue 9. Art. No.: CD009993. DOI: 10.1002/14651858.CD009993.pub2. [<a href="https://pubmed.ncbi.nlm.nih.gov/25177840" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25177840</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD009993.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref63">So
|
|
A, De Meulemeester
|
|
M, Pikhlak
|
|
A, Yucel
|
|
AE, Richard
|
|
D, Murphy
|
|
V
|
|
et al. Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: Results of a multicenter, phase II, dose-ranging study. Arthritis and Rheumatism. 2010; 62(10):3064–3076 [<a href="https://pubmed.ncbi.nlm.nih.gov/20533546" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20533546</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref64">So
|
|
A, DeMeulenmeester
|
|
M, Ycel
|
|
E, Arulmani
|
|
U, Richard
|
|
D, Murphy
|
|
V
|
|
et al. Canakinumab relieves symptoms of acute flares and improves health-related quality of life (HRQoL) in difficult-to-treat gouty arthritis patients by suppressing inflammation: results of a randomized, dose-ranging study. Journal of Allergy and Clinical Immunology. 2011; 127(2 Suppl 1):AB227 [<a href="/pmc/articles/PMC3132043/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3132043</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21439048" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21439048</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref65">Solomon
|
|
DH, Glynn
|
|
RJ, MacFadyen
|
|
JG, Libby
|
|
P, Thuren
|
|
T, Everett
|
|
BM
|
|
et al. Relationship of interleukin-1beta blockade with incident gout and serum uric acid levels: Exploratory analysis of a randomized controlled trial. Annals of Internal Medicine. 2018; 169(8):535–542 [<a href="https://pubmed.ncbi.nlm.nih.gov/30242335" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30242335</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref66">Stewart
|
|
S, Yang
|
|
KCK, Atkins
|
|
K, Dalbeth
|
|
N, Robinson
|
|
PC. Adverse events during oral colchicine use: a systematic review and meta-analysis of randomised controlled trials. Arthritis Research & Therapy. 2020; 22(1):28 [<a href="/pmc/articles/PMC7020579/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7020579</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32054504" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32054504</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref67">Stubbs
|
|
DF, Freeman
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BE. Efficacy comparisons of flurbiprofen and other nonsteroidal anti-inflammatory drugs in arthritic diseases. Current Therapeutic Research - Clinical and Experimental. 1989; 46(3):511–528</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref68">Sturge
|
|
RA, Scott
|
|
JT, Hamilton
|
|
EB, Liyanage
|
|
SP, Dixon
|
|
AS, Davies
|
|
J
|
|
et al. Multicentre trial of naproxen and phenylbutazone in acute gout. Annals of the Rheumatic Diseases. 1977; 36(1):80–82 [<a href="/pmc/articles/PMC1006635/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1006635</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/843115" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 843115</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref69">Terkeltaub
|
|
RA, Furst
|
|
DE, Bennett
|
|
K, Kook
|
|
KA, Crockett
|
|
RS, Davis
|
|
MW. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis and Rheumatism. 2010; 62(4):1060–1068 [<a href="https://pubmed.ncbi.nlm.nih.gov/20131255" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20131255</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref70">Terkeltaub
|
|
RA, Schumacher
|
|
HR, Carter
|
|
JD, Baraf
|
|
HS, Evans
|
|
RR, Wang
|
|
J
|
|
et al. Rilonacept in the treatment of acute gouty arthritis: a randomized, controlled clinical trial using indomethacin as the active comparator. Arthritis Research & Therapy. 2013; 15(1):R25 [<a href="/pmc/articles/PMC3672764/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3672764</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23375025" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23375025</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref71">Underwood
|
|
M. Gout. Clinical Evidence. 2015; 2015 [<a href="/pmc/articles/PMC4365763/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4365763</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25789770" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25789770</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref72">Valdes
|
|
EF. Use of tenoxicam in patients with acute gouty arthritis. European Journal of Rheumatology and Inflammation. 1987; 9(2):133–136 [<a href="https://pubmed.ncbi.nlm.nih.gov/3329106" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3329106</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref73">van
|
|
DC, Wechalekar
|
|
M, Buchbinder
|
|
R, Schlesinger
|
|
N, van
|
|
dHD, Landewé
|
|
R. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database of Systematic Reviews
|
|
2014, Issue 9. Art. No.: CD010120. DOI: 10.1002/14651858.CD010120.pub2. [<a href="https://pubmed.ncbi.nlm.nih.gov/25225849" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25225849</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD010120.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref74">van Echteld
|
|
I, Wechalekar
|
|
MD, Schlesinger
|
|
N, Buchbinder
|
|
R, Aletaha
|
|
D. Colchicine for acute gout. Cochrane Database of Systematic Reviews
|
|
2014, Issue 8. Art. No.: 620615690. DOI: 10.1002/14651858.CD006190.pub2. [<a href="https://pubmed.ncbi.nlm.nih.gov/25123076" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25123076</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD006190.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref75">van Echteld
|
|
IA, van Durme
|
|
C, Falzon
|
|
L, Landewe
|
|
RB, van der Heijde
|
|
DM, Aletaha
|
|
D. Treatment of gout patients with impairment of renal function: a systematic literature review. Journal of Rheumatology - Supplement. 2014; 92:48–54 [<a href="https://pubmed.ncbi.nlm.nih.gov/25180128" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25180128</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref76">Wechalekar
|
|
MD, Vinik
|
|
O, Moi
|
|
JH, Sivera
|
|
F, van Echteld
|
|
IA, van Durme
|
|
C
|
|
et al. The efficacy and safety of treatments for acute gout: results from a series of systematic literature reviews including Cochrane reviews on intraarticular glucocorticoids, colchicine, nonsteroidal antiinflammatory drugs, and interleukin-1 inhibitors. Journal of Rheumatology - Supplement. 2014; 92:15–25 [<a href="https://pubmed.ncbi.nlm.nih.gov/25180124" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25180124</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref77">Wechalekar
|
|
MD, Vinik
|
|
O, Schlesinger
|
|
N, Buchbinder
|
|
R. Intra-articular glucocorticoids for acute gout. Cochrane Database of Systematic Reviews
|
|
2013, Issue 4. Art. No.: 23633379. DOI: 10.1002/14651858.CD009920.pub2. [<a href="https://pubmed.ncbi.nlm.nih.gov/23633379" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23633379</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD009920.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref78">Weiner
|
|
GI, White
|
|
SR, Weitzner
|
|
RI, Rubinstein
|
|
HM. Double-blind study of fenoprofen versus phenylbutazone in acute gouty arthritis. Arthritis and Rheumatism. 1979; 22(4):425–426 [<a href="https://pubmed.ncbi.nlm.nih.gov/371630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 371630</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref79">Willburger
|
|
RE, Mysler
|
|
E, Derbot
|
|
J, Jung
|
|
T, Thurston
|
|
H, Kreiss
|
|
A
|
|
et al. Lumiracoxib 400 mg once daily is comparable to indomethacin 50 mg three times daily for the treatment of acute flares of gout. Rheumatology. 2007; 46(7):1126–1132 [<a href="https://pubmed.ncbi.nlm.nih.gov/17478464" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17478464</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref80">Xu
|
|
L, Liu
|
|
S, Guan
|
|
M, Xue
|
|
Y. Comparison of prednisolone, etoricoxib, and indomethacin in treatment of acute gouty arthritis: An open-label, randomized, controlled trial. Medical Science Monitor. 2016; 22:810–817 [<a href="/pmc/articles/PMC4791088/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4791088</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26965791" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26965791</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref81">Xu
|
|
Z, Zhang
|
|
R, Zhang
|
|
D, Yao
|
|
J, Shi
|
|
R, Tang
|
|
Q
|
|
et al. Peptic ulcer hemorrhage combined with acute gout: analyses of treatment in 136 cases. International Journal of Clinical and Experimental Medicine. 2015; 8(4):6193–6199 [<a href="/pmc/articles/PMC4483932/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4483932</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26131224" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26131224</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref82">Yu
|
|
J, Lu
|
|
H, Zhou
|
|
J, Xie
|
|
Z, Wen
|
|
C, Xu
|
|
Z. Oral prednisolone versus non-steroidal anti-inflammatory drugs in the treatment of acute gout: a meta-analysis of randomized controlled trials. Inflammopharmacology. 2018; 26(3):717–723 [<a href="https://pubmed.ncbi.nlm.nih.gov/29357007" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29357007</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref83">Yu
|
|
Y, Zhou
|
|
Q, Yang
|
|
N, Zhang
|
|
J, Song
|
|
X, Gao
|
|
L
|
|
et al. Treatment for acute flares of gout: An overview of systematic reviews. Chinese Journal of Evidence-Based Medicine. 2018; 18(10):1080–1085</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref84">Zeng
|
|
L, Qasim
|
|
A, Neogi
|
|
T, Fitzgerald
|
|
JD, Dalbeth
|
|
N, Mikuls
|
|
TR
|
|
et al. Comparative efficacy and safety of pharmacological interventions in patients experiencing a gout flare: a systematic review and network meta-analysis. Arthritis Care Res (Hoboken). 2020; [<a href="/pmc/articles/PMC10572733/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10572733</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32741131" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32741131</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref85">Zhang
|
|
S, Zhang
|
|
Y, Liu
|
|
P, Zhang
|
|
W, Ma
|
|
JL, Wang
|
|
J. Efficacy and safety of etoricoxib compared with NSAIDs in acute gout: a systematic review and a meta-analysis. Clinical Rheumatology. 2016; 35(1):151–158 [<a href="https://pubmed.ncbi.nlm.nih.gov/26099603" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26099603</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="niceng219er4.s1.1.ref86">Zhang
|
|
YK, Yang
|
|
H, Zhang
|
|
JY, Song
|
|
LJ, Fan
|
|
YC. Comparison of intramuscular compound betamethasone and oral diclofenac sodium in the treatment of acute attacks of gout. International Journal of Clinical Practice. 2014; 68(5):633–638 [<a href="https://pubmed.ncbi.nlm.nih.gov/24472084" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24472084</span></a>]</div></dd></dl></dl></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng219er4.appa"><h3>Appendix A. Review protocols</h3><p id="niceng219er4.appa.et1"><a href="/books/NBK583527/bin/niceng219er4-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for pharmacological and non -pharmacological interventions for managing gout flares</a><span class="small"> (PDF, 194K)</span></p><p id="niceng219er4.appa.et2"><a href="/books/NBK583527/bin/niceng219er4-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic review protocol</a><span class="small"> (PDF, 139K)</span></p></div><div id="niceng219er4.appb"><h3>Appendix B. Literature search strategies</h3><ul><li class="half_rhythm"><div>What is the clinical and cost effectiveness of pharmacological interventions (including NSAIDs, colchicine, corticosteroids and IL-1 inhibitors) and non-pharmacological interventions for managing gout flares?</div></li></ul><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng219er4.s1.1.ref41" rid="niceng219er4.s1.1.ref41"><sup>41</sup></a></p><p>For more information, please see the <a href="/books/NBK583527/bin/methods-pdf-11132544061.pdf">Methodology</a> review published as part of the accompanying documents for this guideline.</p><p id="niceng219er4.appb.et1"><a href="/books/NBK583527/bin/niceng219er4-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 214K)</span></p><p id="niceng219er4.appb.et2"><a href="/books/NBK583527/bin/niceng219er4-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 171K)</span></p></div><div id="niceng219er4.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng219er4.appc.et1"><a href="/books/NBK583527/bin/niceng219er4-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of pharmacological and non-pharmacological management of gout flares</a><span class="small"> (PDF, 112K)</span></p></div><div id="niceng219er4.appd"><h3>Appendix D. Effectiveness evidence</h3><p id="niceng219er4.appd.et1"><a href="/books/NBK583527/bin/niceng219er4-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (535K)</span></p></div><div id="niceng219er4.appe"><h3>Appendix E. Forest plots</h3><p id="niceng219er4.appe.et1"><a href="/books/NBK583527/bin/niceng219er4-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.1. Colchicine versus placebo</a><span class="small"> (PDF, 127K)</span></p><p id="niceng219er4.appe.et2"><a href="/books/NBK583527/bin/niceng219er4-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.2. Corticosteroids versus NSAIDs</a><span class="small"> (PDF, 203K)</span></p><p id="niceng219er4.appe.et3"><a href="/books/NBK583527/bin/niceng219er4-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.3. NSAIDs versus colchicine</a><span class="small"> (PDF, 199K)</span></p><p id="niceng219er4.appe.et4"><a href="/books/NBK583527/bin/niceng219er4-appe-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.4. IL1-inhibitors versus corticosteroids</a><span class="small"> (PDF, 186K)</span></p><p id="niceng219er4.appe.et5"><a href="/books/NBK583527/bin/niceng219er4-appe-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.5. Ice therapy plus corticosteroids and colchicine versus corticosteroids and colchicine</a><span class="small"> (PDF, 165K)</span></p></div><div id="niceng219er4.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng219er4.appf.et1"><a href="/books/NBK583527/bin/niceng219er4-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 18. Clinical evidence profile: Colchicine versus placebo</a><span class="small"> (PDF, 172K)</span></p><p id="niceng219er4.appf.et2"><a href="/books/NBK583527/bin/niceng219er4-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 19. Clinical evidence profile: Corticosteroids versus NSAIDs</a><span class="small"> (PDF, 252K)</span></p><p id="niceng219er4.appf.et3"><a href="/books/NBK583527/bin/niceng219er4-appf-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 20. Clinical evidence profile: NSAIDs versus colchicine</a><span class="small"> (PDF, 291K)</span></p><p id="niceng219er4.appf.et4"><a href="/books/NBK583527/bin/niceng219er4-appf-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 21. Clinical evidence profile: IL-1 inhibitors versus corticosteroids</a><span class="small"> (PDF, 226K)</span></p><p id="niceng219er4.appf.et5"><a href="/books/NBK583527/bin/niceng219er4-appf-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 22. Clinical evidence profile: ice plus prednisone and colchicine versus prednisone and colchicine</a><span class="small"> (PDF, 186K)</span></p></div><div id="niceng219er4.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng219er4.appg.et1"><a href="/books/NBK583527/bin/niceng219er4-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (181K)</span></p></div><div id="niceng219er4.apph"><h3>Appendix H. Economic evidence tables</h3><p id="niceng219er4.apph.et1"><a href="/books/NBK583527/bin/niceng219er4-apph-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (164K)</span></p></div><div id="niceng219er4.appi"><h3>Appendix I. Health economic model</h3><p>No original health economic modelling was undertaken for this review question.</p></div><div id="niceng219er4.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng219er4.appj.s1"><h4>Clinical studies</h4><p id="niceng219er4.appj.et1"><a href="/books/NBK583527/bin/niceng219er4-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (140K)</span></p></div><div id="niceng219er4.appj.s2"><h4>Health Economic studies</h4><p>None.</p></div></div><div id="niceng219er4.appk"><h3>Appendix K. Research recommendation – full details</h3><div id="niceng219er4.appk.s1"><h4>F.1.1. Research recommendation</h4><p>In people with gout (including people with gout and chronic kidney disease), what is the clinical and cost effectiveness of colchicine compared with corticosteroids for managing gout flares?</p></div><div id="niceng219er4.appk.s2"><h4>F.1.2. Why this is important</h4><p>Gout flares are excruciatingly painful and require rapid treatment with non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids. Flares are most frequently treated with NSAIDs, although many people with gout have contraindications to NSAIDs, e.g. chronic kidney disease or cardiovascular disease. RCTs show that NSAIDs have similar effectiveness for flares to colchicine and corticosteroids, however, there has never been a direct comparison of the effectiveness and safety of colchicine and corticosteroids.</p></div><div id="niceng219er4.appk.s3"><h4>F.1.3. Rationale for research recommendation</h4><p id="niceng219er4.appk.et1"><a href="/books/NBK583527/bin/niceng219er4-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (149K)</span></p></div><div id="niceng219er4.appk.s4"><h4>F.1.4. Modified PICO table</h4><p id="niceng219er4.appk.et2"><a href="/books/NBK583527/bin/niceng219er4-appk-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (135K)</span></p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.3.1 to 1.3.5 and research recommendations in the NICE guideline</p><p>National Institute for Health and Care Excellence</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK583527</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36063467" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36063467</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng219er4tab1"><div id="niceng219er4.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng219er4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng219er4.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion: Adults (18 years and older) with gout flares</p>
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<p>Strata:
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<ul><li class="half_rhythm"><div>People with chronic kidney disease (stage 3)</div></li><li class="half_rhythm"><div>People with chronic kidney disease (stage 4-5)</div></li><li class="half_rhythm"><div>People without chronic kidney disease or people with CKD stages 1-2</div></li><li class="half_rhythm"><div>Mixed population (people with CKD and people without CKD)</div></li></ul>
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Exclusion: People with calcium pyrophosphate crystal deposition, including pseudogout</p>
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</td></tr><tr><th id="hd_b_niceng219er4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention(s)</th><td headers="hd_b_niceng219er4.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>NSAIDs (commonly used in clinical practice in the UK)</div></li><li class="half_rhythm"><div>Celecoxib</div></li><li class="half_rhythm"><div>Diclofenac sodium</div></li><li class="half_rhythm"><div>Etoricoxib</div></li><li class="half_rhythm"><div>Ibuprofen</div></li><li class="half_rhythm"><div>Indomethacin</div></li><li class="half_rhythm"><div>Meloxicam</div></li><li class="half_rhythm"><div>Naproxen</div></li></ul>
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<ul><li class="half_rhythm"><div>Colchicine</div></li><li class="half_rhythm"><div>Corticosteroids (commonly used in clinical practice in the UK)</div></li><li class="half_rhythm"><div>Methylprednisolone</div></li><li class="half_rhythm"><div>Prednisolone</div></li><li class="half_rhythm"><div>Triamcinolone</div></li></ul>
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<ul><li class="half_rhythm"><div>IL-1 inhibitors (commonly used in clinical practice in the UK)</div></li><li class="half_rhythm"><div>Anakinra</div></li><li class="half_rhythm"><div>Canakinumab</div></li></ul>
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<ul><li class="half_rhythm"><div>Non-pharmacological interventions - rest, elevation, bed cages and ice</div></li><li class="half_rhythm"><div>Combinations (pharmacological + non-pharmacological)</div></li></ul>
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Combine all doses (doses much higher than standard doses will be excluded) Within drug class comparisons will not be made, e.g. IL-1 inhibitors will be combined in analyses</td></tr><tr><th id="hd_b_niceng219er4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison(s)</th><td headers="hd_b_niceng219er4.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Compared to each other</div></li><li class="half_rhythm"><div>Standard care/usual care</div></li><li class="half_rhythm"><div>Control/no intervention</div></li><li class="half_rhythm"><div>Placebo</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng219er4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng219er4.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All outcomes are considered equally important for decision making and therefore have all been rated as critical:
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<ul><li class="half_rhythm"><div>health-related quality of life (e.g. as described by SF-36, Gout Assessment Questionnaire (GAQ) and the Gout Impact Scale (GIS) or other validated gout-specific HRQoL measures</div></li><li class="half_rhythm"><div>pain (measured on a visual analogue scale (VAS) or numerical rating scale such as the five-point Likert scale, or reported as pain relief of 50% or greater)</div></li><li class="half_rhythm"><div>joint swelling/ joint inflammation</div></li><li class="half_rhythm"><div>joint tenderness</div></li><li class="half_rhythm"><div>patient global assessment of treatment success (response to treatment) (e.g. Likert scales, visual analogue scales (VAS), numerical ratings scales (NRS))</div></li><li class="half_rhythm"><div>adverse events – (1) cardiovascular, (2) renal and (3) gastrointestinal (e.g. diarrhoea)</div></li><li class="half_rhythm"><div>admissions (hospital and A&E/urgent care)</div></li><li class="half_rhythm"><div>GP visits</div></li></ul>
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Timepoints: short-term (up to two weeks), medium-term (two to six weeks) and long-term (> six weeks)</td></tr><tr><th id="hd_b_niceng219er4.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng219er4.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>RCT</p>
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<p>Systematic reviews of RCTs</p>
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<p>If insufficient RCT evidence is available (no or little evidence for interventions/comparisons), search for non-randomised studies (prospective and retrospective cohort studies will be considered if they adjust for key confounders:
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<ul><li class="half_rhythm"><div>Age</div></li><li class="half_rhythm"><div>Gender</div></li><li class="half_rhythm"><div>Previous treatment (non-pharmacological and pharmacological use)</div></li></ul>
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Published NMAs will be considered for inclusion.</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab2"><div id="niceng219er4.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention and comparison</th><th id="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Janssens 2008<a class="bibr" href="#niceng219er4.s1.1.ref25" rid="niceng219er4.s1.1.ref25"><sup>25</sup></a></p>
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<p>RCT</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention (n=60)</p>
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<p>Corticosteroids - Prednisolone 35mg once a day and look alike placebo naproxen twice a day for 5 days.</p>
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<p>Concurrent medication/care: no NSAIDs or other analgesics (including colchicine) within 24 h before baseline assessments or for the duration of the trial.</p>
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<p>Comparison (n=60)</p>
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<p>NSAIDs - Naproxen 500 mg twice a day and placebo capsule prednisolone for 5 days.</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>n=120</p>
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<p>Participants were patients with monoarticular gout arthritis confirmed by identification of monosodium urate crystals in the synovial fluid of the affected joint</p>
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<p>Age - mean years (SD): Prednisolone group 57.3 (12.2), naproxen group 57.7 (13.4).</p>
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<p>Gender (M:F): Prednisolone group 54/6, naproxen group 53/7.</p>
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<p>Ethnicity: not reported</p>
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<p>Netherlands</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Pain (VAS) at 90 hours</p>
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<p>Adverse events - gastrointestinal at 90 hours</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Liu 2019<a class="bibr" href="#niceng219er4.s1.1.ref32" rid="niceng219er4.s1.1.ref32"><sup>32</sup></a></p>
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<p>RCT</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention (n=61)</p>
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<p>Colchicine. Patients in the colchicine group received colchicine 0.5 mg orally, 3 times daily, for 5 days, later changed to once daily (“later” was not specified)</p>
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<p>Comparison (n=61)</p>
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<p>NSAIDs - Etoricoxib. Patients in the etoricoxib group received etoricoxib 120mg orally (Hangzhou MSD Pharmaceutical Co., Ltd), once daily, for 5 days, later changed to 60 mg orally once daily. (“Later” was not specified)</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>n=122</p>
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<p>Patients from 18 to 70 years old with newly diagnosed acute gouty arthritis; an onset of acute gouty arthritis duration of less than 48 h and no administration of colchicine, NSAID or glucocorticoids; no administration of medications affecting uric acid metabolism over the last 3 months; without diseases affecting uric acid metabolism.</p>
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<p>Age - mean years (SD): Etoricoxib group 44(9); Colchicine 43(9)</p>
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<p>Gender (M:F): Etoricoxib group 49/4; Colchicine 47/5</p>
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<p>Ethnicity: not reported</p>
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<p>China</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Joint pain scores at 10 days</p>
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<p>Adverse events – gastrointestinal at 10 days</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gastrointestinal events included: diarrhoea, vomiting</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Man 2007<a class="bibr" href="#niceng219er4.s1.1.ref37" rid="niceng219er4.s1.1.ref37"><sup>37</sup></a></p>
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<p>RCT</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention (n=46)</p>
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<p>NSAIDs - Indomethacin. In the indomethacin group, each patient initially received diclofenac (3 mL; 75mg) intramuscularly, indomethacin 50 mg orally, acetaminophen 1 g orally, and 6 tablets of prednisolone like placebo orally and was observed for 120 minutes. The patient was then given a 5-day prescription of indomethacin (50 mg orally every 8 hours for 2 days, followed by indomethacin 25 mg every 8 hours for another 3 days), 6 tablets of prednisolone-like placebo once a day, and acetaminophen 1 g every 6 hours as required. Duration 5 days.</p>
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<p>Comparisons (n=44)</p>
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<p>Corticosteroids - Prednisolone. In the prednisolone group, each patient initially received an intramuscular placebo injection (3 mL), prednisolone 30 mg (6 times 5 mg) orally, acetaminophen 1g (2 tablets) orally, and indomethacin-like placebo (2 tablets) orally and was then observed for 120 minutes. The patient was then given a 5-day prescription of indomethacin-like placebo, prednisolone 30 mg orally once per day, and acetaminophen 1g every 6 hours as required.</p>
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</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>n=90</p>
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<p>Patients were included if they had a clinical diagnosis of acute arthritis suggestive of gout.</p>
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<p>Age - mean years (SD): Indomethacin 66 (16) Prednisolone 64 (15)</p>
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<p>Gender (M/F): Indomethacin 39/7, Prednisolone 35/9</p>
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<p>Ethnicity: not reported</p>
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<p>Australia</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adverse events – gastrointestinal events at 14 days</p>
|
|
<p>Adverse events – cardiovascular events at 14 days</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Gastrointestinal events included: epigastric pain, other abdominal pain, indigestion, vomiting, diarrhoea, gastrointestinal haemorrhage and nausea.</p>
|
|
<p>Cardiovascular events included: chest pain</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Rainer 2016<a class="bibr" href="#niceng219er4.s1.1.ref46" rid="niceng219er4.s1.1.ref46"><sup>46</sup></a></p>
|
|
<p>RCT</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intervention (n=208)</p>
|
|
<p>NSAIDs - Indomethacin. In the indomethacin group, patients initially received 50 mg (two 25-mg tablets) of oral indomethacin 3 times a day and 6 tablets of oral placebo prednisolone once a day for 2 days, followed by 25 mg of indomethacin 3 times a day and 6 tablets of placebo prednisolone once a day for 3 days.</p>
|
|
<p>Comparison (n=208)</p>
|
|
<p>Corticosteroids - Prednisolone. In the prednisolone group, patients initially received 30 mg (three 10-mg tablets) of oral prednisolone once a day and 2 tablets of placebo indomethacin 3 times a day for 2 days, followed by 30 mg (three 10-mg tablets) of prednisolone once a day and 1 tablet of placebo indomethacin 3 times a day for 3 days. Patients took the first dose in the presence of one of the investigators.</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=416</p>
|
|
<p>Patients with the diagnosis of acute gout</p>
|
|
<p>Age - mean years (SD): Indomethacin group 64.37(16.01); Prednisolone group 65.91(14.95)</p>
|
|
<p>Gender (M/F): Indomethacin group 164/44; Prednisolone group 145/63</p>
|
|
<p>Ethnicity: not reported</p>
|
|
<p>Hong Kong (China)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients with clinically significant change in pain score (13 mm on a 100-mm VAS) - at rest at 14 days</p>
|
|
<p>Patients with clinically significant change in pain score (13 mm on a 100-mm VAS) - with activity at 14 days</p>
|
|
<p>Joint tenderness (mean change from baseline to day 14) at 14 days</p>
|
|
<p>Adverse events - gastrointestinal</p>
|
|
<p>Visited ED at 14 days</p>
|
|
<p>Visited Outpatient department at 14 days</p>
|
|
<p>GP visits at 14 days</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gastrointestinal events included: nausea, vomiting, abdominal pain, indigestion.</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Roddy 2020<a class="bibr" href="#niceng219er4.s1.1.ref47" rid="niceng219er4.s1.1.ref47"><sup>47</sup></a></p>
|
|
<p>RCT</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intervention (n=200)</p>
|
|
<p>NSAIDs – Naproxen - Single initial dose of oral naproxen 750 mg (three 250 mg tablets) followed by 250 mg (one tablet) every 8 hours for up to 7 days. Co-prescription of a proton-pump inhibitor was at the GP’s discretion.</p>
|
|
<p>Comparison (n=199)</p>
|
|
<p>Oral colchicine 500 mg (one tablet) every 8 hours for 4 days. Participants prescribed a statin were advised to omit the statin during colchicine treatment</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=399</p>
|
|
<p>Participants consulting for a current gout flare</p>
|
|
<p>Age mean- years (SD): Naproxen group - 58.7(14.4), Colchicine 60 (13.4)</p>
|
|
<p>Gender (M/F): Naproxen group - 173/27; Colchicine group - 174/25</p>
|
|
<p>Ethnicity: not reported</p>
|
|
<p>UK</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Complete pain resolution at 7 days</p>
|
|
<p>Complete pain resolution at 4 weeks</p>
|
|
<p>Patient assessment of global treatment response (completely/much better) at 7 days</p>
|
|
<p>Patient assessment of global treatment response (completely/much better) at 4 weeks</p>
|
|
<p>Adverse events – gastrointestinal events at 7 days</p>
|
|
<p>Adverse events – gastrointestinal events at 4 weeks</p>
|
|
<p>Consultation re-attendance for gout during 4-week follow-up - emergency department</p>
|
|
<p>Consultation Re-attendance for gout during 4-week follow-up - GP at 4 weeks</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gastrointestinal events included: nausea and vomiting, diarrhoea, dyspepsia, constipation, abdominal pain</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saag, 2021<a class="bibr" href="#niceng219er4.s1.1.ref50" rid="niceng219er4.s1.1.ref50"><sup>50</sup></a></td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intervention (n=56)</p>
|
|
<p>IL-1 inhibitors - Anakinra 100 mg by subcutaneous injection</p>
|
|
<p>Comparison (n=55):</p>
|
|
<p>Corticosteroids - Triamcinolone 40mg single injection on day 1</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>N= 165 (111 used in this analysis as anakinra 200mg group was not relevant to this review)</p>
|
|
<p>Patients having a gout flare and who have had ≥1 episode of intolerance or non-responsiveness to NSAIDs and colchicine.</p>
|
|
<p>Age (median, range): Anakinra 100mg group: 53.5 (25-79), Triamcinolone group: 56.0 (30-83)</p>
|
|
<p>Gender: Anakinra 100mg group: 48 males (85.7%)</p>
|
|
<p>Triamcinolone group: 48 males (87.3%)</p>
|
|
<p>Ethnicity: Anakinra 100mg group: White 38 (67.9%), Black 15 (26.8%), Asian 3 (5,4%)</p>
|
|
<p>Triamcinolone group: White 39 (70.9%), Black 15 (27.3%), Asian 1 (1.8%)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Pain - VAS change from baseline at 24-72 hours from the start of flares 1, 2 and 3 (during the 5 days treatment period)</p>
|
|
<p>Any adverse event during the study period, including the extension period (up to 2 years)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>There were two anakinra groups, only the 100mg group was relevant to the protocol and was included.</p>
|
|
<p>Previous non-response to NSAIDs/colchicine</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Schlesinger 2002<a class="bibr" href="#niceng219er4.s1.1.ref53" rid="niceng219er4.s1.1.ref53"><sup>53</sup></a></p>
|
|
<p>RCT</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intervention (n=10)</p>
|
|
<p>Combination interventions - Pharmacological plus non-pharmacological. received topical ice therapy, oral corticosteroids (prednisone tapered from 30 mg to 0 over 6 days (30 mg 2 days, 20 mg × 2 days, 10 mg × 2 days) and colchicine 0.6 mg/day. Ice therapy, by application of ice packs with self-ties on the inflamed target joint for 30 min 4 times/day, was given to all patients in Group A. The patients were followed for one week.</p>
|
|
<p>Comparison (n=9)</p>
|
|
<p>No Ice therapy + oral corticosteroids (prednisone tapered from 30 mg to 0 over 6 days (30 mg 2 days, 20 mg × 2 days, 10 mg × 2 days) and colchicine 0.6 mg/day. No ice therapy. Duration 6 days.</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=19</p>
|
|
<p>Patients with acute gouty attacks</p>
|
|
<p>Age - mean (SD): age not reported</p>
|
|
<p>Gender (M/F): age not reported</p>
|
|
<p>Ethnicity: not reported</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Pain at 1 week</p>
|
|
<p>Joint swelling/joint inflammation - joint circumference (cm) at 1 week</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Schlesinger 2012<a class="bibr" href="#niceng219er4.s1.1.ref51" rid="niceng219er4.s1.1.ref51"><sup>51</sup></a>: β-RELIEVED trial and β-RELIEVED II trial RCT</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>β-RELIEVED trial: Intervention - (n=115):</p>
|
|
<p>IL-1 inhibitors - Canakinumab. canakinumab single dose 150 mg by subcutaneous injection</p>
|
|
<p>Comparison (n=115):</p>
|
|
<p>Corticosteroids - Triamcinolone acetonide single dose 40 mg intramuscular injection.</p>
|
|
<p>β-RELIEVED-II trial:</p>
|
|
<p>Intervention (n=112):</p>
|
|
<p>IL-1 inhibitors - Canakinumab. canakinumab single doses 150 mg by subcutaneous injection</p>
|
|
<p>Comparison (n=114):</p>
|
|
<p>Corticosteroids - Triamcinolone. Triamcinolone acetonide 40 mg intramuscular injection (B-RELIEVED-II sub-study). Duration single dose.</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=456</p>
|
|
<p>Patients with acute arthritis of primary gout, with a history of ≥ three self-reported flares in the previous 12 months, having an acute flare for ≤five days characterised by baseline pain intensity ≥50 mm on a 0–100 mm visual analogue scale (VAS)</p>
|
|
<p>Age - mean years (SD): Canakinumab group - 52.3 (11.8), triamcinolone group 53.6(11.5)</p>
|
|
<p>Gender (M/F): 414/40</p>
|
|
<p>Ethnicity (%): Canakinumab group - Caucasian 74.2 %, Black – 11.6%; Asian −5.8%; Other – 8.419 Triamcinolone group - Caucasian – 76.9%; Black – 10.5%; Asian −5.2%; Other 7.4%</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Physician assessment of swelling (OR) - β-RELIEVED at 7 days</p>
|
|
<p>Pain 100-mm visual analogue scale at 72 hours (B-Relieved)</p>
|
|
<p>Physician assessment of tenderness (OR) - β-RELIEVED at 7 days</p>
|
|
<p>Patient global assessment (OR) - β-RELIEVED at 7 days</p>
|
|
<p>Any adverse event - β-RELIEVED - long term at 24 weeks</p>
|
|
<p>Physician assessment of swelling (OR) - β-RELIEVED-II at 7 days</p>
|
|
<p>Pain 100-mm visual analogue scale at 72 hours (B-Relieved-II)</p>
|
|
<p>Physician assessment of tenderness (OR) - β-RELIEVED at 7 days</p>
|
|
<p>Patient global assessment (OR) - β-RELIEVED-II at 7 days</p>
|
|
<p>Any adverse event - β-RELIEVED-II - long term at 24 weeks</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The study also reported all outcomes at 72 hours</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>So 2010<a class="bibr" href="#niceng219er4.s1.1.ref63" rid="niceng219er4.s1.1.ref63"><sup>63</sup></a> (Schlesinger 2011<a class="bibr" href="#niceng219er4.s1.1.ref52" rid="niceng219er4.s1.1.ref52"><sup>52</sup></a>)</p>
|
|
<p>RCT</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intervention (n=28):</p>
|
|
<p>IL-1 inhibitors - Canakinumab. Canakinumab 150 mg by subcutaneous injection and saline by intramuscular injection</p>
|
|
<p>Comparison (n=57):</p>
|
|
<p>Corticosteroids - Triamcinolone. triamcinolone acetonide (40 mg) intramuscularly and a subcutaneous placebo injection on day 1</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=85</p>
|
|
<p>Patients with a history of at least 1 previous gout flare, also required to have had an acute gout flare for ≤5 days, have a baseline pain intensity of ≥50 mm on a visual analogue scale (VAS) ranging from no pain (0 mm) to unbearable pain (100 mm),</p>
|
|
<p>Age - mean years (SD): Canakinumab 50.6(15.38); Triamcinolone acetonide 52.4(11.55)</p>
|
|
<p>Gender (M:F): Canakinumab 28/0; Triamcinolone acetonide 55/2</p>
|
|
<p>Ethnicity:</p>
|
|
<p>Canakinumab vs triamcinolone acetonide</p>
|
|
<p>White 85.7% vs 94.7%</p>
|
|
<p>Black 3.6% vs 5.3%</p>
|
|
<p>Asian 7.1% vs 0%</p>
|
|
<p>Other 3.6% vs 0%</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>SF 36 - physical component at 7 days</p>
|
|
<p>Pain - VAS change from baseline at 7 days</p>
|
|
<p>Patient global assessment - Excellent at 7 days</p>
|
|
<p>Patient global assessment - Good at 7 days</p>
|
|
<p>Any adverse events at 7 days</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Dose ranging study 150 mg single dose of Canakinumab was used for this review</p>
|
|
<p>Other doses (not relevant): 10 mg, 25 mg, 50 mg or 90mg as a single dose;</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Terkeltaub 2010<a class="bibr" href="#niceng219er4.s1.1.ref69" rid="niceng219er4.s1.1.ref69"><sup>69</sup></a></p>
|
|
<p>RCT</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intervention (n=74)</p>
|
|
<p>Colchicine - (1.2 mg followed by 0.6 mg in 1 hour followed by placebo doses every hour for 5 hours [1.8 mg total])</p>
|
|
<p>Comparison (n=59)</p>
|
|
<p>Placebo - (2 placebo capsules initially, followed by 1 placebo capsule every hour for 6 hours).</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=185</p>
|
|
<p>Male and postmenopausal female patients ≥18 years of age with a confirmed past diagnosis of gout (according to the American College of Rheumatology [ACR] classification criteria and having had ≥2 gout flares within the prior 12 months were eligible for randomization.</p>
|
|
<p>Age - mean years (SD): 51.5 (11.12)</p>
|
|
<p>Gender (M/F): 176/9</p>
|
|
<p>Ethnicity:</p>
|
|
<p>Colchicine vs placebo</p>
|
|
<p>American Indian/Alaska Native – 1.4% vs 0%</p>
|
|
<p>Asian – 1.4% vs 1.7%</p>
|
|
<p>Black/African American – 5.4% vs 18.6%</p>
|
|
<p>White/Caucasian – 89.2% vs 79.7%</p>
|
|
<p>Other – 2.7% vs 0%</p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Pain - treatment response based on target joint pain score 32 hours after first dose - ≥ 50% pain reduction (number of patients) at 32 hours</p>
|
|
<p>Adverse events Gastrointestinal</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Low dose of Colchicine was used for this review</p>
|
|
<p>Another dose was reported (not relevant) - high dose - (1.2 mg followed by 0.6 mg every hour for 6 hours [4.8 mg total]))</p>
|
|
<p>Adverse events included: diarrhoea, nausea, vomiting</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er4.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Xu 2016<a class="bibr" href="#niceng219er4.s1.1.ref80" rid="niceng219er4.s1.1.ref80"><sup>80</sup></a></p>
|
|
<p>RCT</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Intervention (n=41)</p>
|
|
<p>Corticosteroids - Prednisolone (35 mg daily,</p>
|
|
<p>Comparison 1 (n=46)</p>
|
|
<p>NSAIDs - Etoricoxib (120 mg qd, Duration 4 days.</p>
|
|
<p>Comparison 2 (n=45)</p>
|
|
<p>NSAIDs - Indomethacin. Etoricoxib (120 mg daily, Duration 4 days</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>n=132</p>
|
|
<p>Inclusion criteria were: 1) gout attacks within 72 hours of screening; 2) The degree of pain in the index joint was at least moderate (2 on a 5-point Likert scale) at baseline; and 3) the index joint was defined as the joint that was the most painful at the time of randomization.</p>
|
|
<p>Age - mean (SD): prednisolone group - 44.03 (15.37), Etoricoxib 44.43 (15.08), indomethacin 43.81 (12.29).</p>
|
|
<p>Gender (M:F): male (%) prednisolone group - 100%, Etoricoxib 100%, indomethacin 97.2%.</p>
|
|
<p>Ethnicity: not reported</p>
|
|
<p>China</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Pain at 4 days</p>
|
|
<p>Swelling at 4 days</p>
|
|
<p>Joint tenderness at 4 days</p>
|
|
<p>Adverse events - gastrointestinal at 4 days</p>
|
|
</td><td headers="hd_h_niceng219er4.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events included: gastric or abdominal pain</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab3"><div id="niceng219er4.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: Colchicine versus placebo</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab3_1_1_1_1" style="text-align:center;vertical-align:top;">Outcomes</th><th id="hd_h_niceng219er4.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab3_1_1_1_2" style="text-align:center;vertical-align:top;">No of participants (studies) Follow up</th><th id="hd_h_niceng219er4.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab3_1_1_1_3" style="text-align:center;vertical-align:top;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng219er4.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab3_1_1_1_4" style="text-align:center;vertical-align:top;">Relative effect (95% CI)</th><th id="hd_h_niceng219er4.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:top;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er4.tab3_1_1_1_5" id="hd_h_niceng219er4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk with placebo</th><th headers="hd_h_niceng219er4.tab3_1_1_1_5" id="hd_h_niceng219er4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk difference with Colchicine</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Pain - Proportion with 50% or greater decrease in pain score (VAS) from baseline – Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>132</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>a</sup></td><td headers="hd_h_niceng219er4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 2.43 (1.30 to 4.54)</td><td headers="hd_h_niceng219er4.tab3_1_1_1_5 hd_h_niceng219er4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">172 per 1,000</td><td headers="hd_h_niceng219er4.tab3_1_1_1_5 hd_h_niceng219er4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">247 more per 1,000 (52 more to 610 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events - gastrointestinal (diarrhoea and vomiting) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>133</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.26 (0.67 to 2.39)</td><td headers="hd_h_niceng219er4.tab3_1_1_1_5 hd_h_niceng219er4.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">203 per 1,000</td><td headers="hd_h_niceng219er4.tab3_1_1_1_5 hd_h_niceng219er4.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">53 more per 1,000 (67 fewer to 283 more)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er4.tab3_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng219er4.tab3_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.. GRADE default MIDs used for all outcomes, for dichotomous outcomes MIDs were taken to be RRs of 0.8 and 1.25.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab4"><div id="niceng219er4.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Corticosteroids versus NSAIDs</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab4_1_1_1_1" style="text-align:center;vertical-align:top;">Outcomes</th><th id="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab4_1_1_1_2" style="text-align:center;vertical-align:top;">No of participants (studies) Follow up</th><th id="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab4_1_1_1_3" style="text-align:center;vertical-align:top;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab4_1_1_1_4" style="text-align:center;vertical-align:top;">Relative effect (95% CI)</th><th id="hd_h_niceng219er4.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:top;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er4.tab4_1_1_1_5" id="hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk with NSAIDs</th><th headers="hd_h_niceng219er4.tab4_1_1_1_5" id="hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk difference with Corticosteroids</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pain (VAS 0-100) at 90 hours - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>118</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">mean 12.9 (SD 18.1)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 3.9 higher (3.77 lower to 11.57 higher)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pain - Number of patients with clinically significant change in pain score (13 mm on a 100-mm VAS) - at rest - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>416</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.91 (0.75 to 1.10)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">534 per 1,000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">48 fewer per 1,000 (133 fewer to 53 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pain - Number of patients with clinically significant change in pain score (13 mm on a 100-mm VAS) - with activity - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>416</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.06 (0.95 to 1.19)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">726 per 1,000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">44 more per 1,000 (36 fewer to 138 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint tenderness - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>416</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The mean joint tendernesswas 0</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.05 lower (0.33 lower to 0.23 higher)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events- gastrointestinal (abdominal pain) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>737</p>
|
|
<p>(4 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>c</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.60 (0.22 to 1.67)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">132 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">53 fewer (103 fewer to 89 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events- gastrointestinal indigestion)- Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>506</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.52 (0.30 to 0.91)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">130 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">62 fewer per 1000 (91 fewer to 12 fewer)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events- gastrointestinal (nausea)- Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>506</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.26 (0.12 to 0.59)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">106 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">79 fewer per 1000 (94 fewer to 44 fewer)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events- gastrointestinal (vomiting)- Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>506</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.10 (0.02 to 0.56)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">50 fewer per 1000 (54 fewer to 24 fewer)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events- gastrointestinal (diarrhoea) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 0.14 (0.01 to 1.33)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">70 fewer per 1000 (from 150 fewer to 20 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events- gastrointestinal (GI haemorrhage) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 0.13 (0.02 to 0.78)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">109 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">110 fewer per 1000 (from 210 fewer to 10 fewer)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events - cardiovascular - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 0.14 (0.00 to 7.13)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19 fewer per 1000 (22 fewer to 115 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of patients visited ED - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>416</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 1.22 (0.73 to 2.04)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">111 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">24 more per 1000 (30 fewer to 115 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of patients visited outpatient department - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>416</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 0.13 (0.02 to 0.95)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">17 fewer per 1000 (19 fewer to 1 fewer)</td></tr><tr><td headers="hd_h_niceng219er4.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">GP visits - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>416</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>b</sup></td><td headers="hd_h_niceng219er4.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RR 0.58 (0.28 to 1.19)</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">91 per 1000</td><td headers="hd_h_niceng219er4.tab4_1_1_1_5 hd_h_niceng219er4.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">38 fewer per 1000 (66 fewer to 17 more)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er4.tab4_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng219er4.tab4_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs. Established MIDs used for VAS continuous scale - improvements of ≥ 10 points on a 1-100 scale; GRADE default MIDs used for all other outcomes. For dichotomous outcomes MIDs were taken to be RRs of 0.8 and 1.25. For continuous outcomes 0.5 × baseline SD was calculated: joint tenderness (0.5 × baseline SD of control group as baseline values were not reported in the paper): 0.74.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng219er4.tab4_3"><p class="no_margin">Downgraded by 1 or 2 increments because: The point estimate varies widely across studies, subgroup analysis could not be performed. I<sup>2 =</sup> 65%, therefore a random effects model was used.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab5"><div id="niceng219er4.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: NSAIDs versus colchicine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab5_1_1_1_1" style="text-align:center;vertical-align:top;">Outcomes</th><th id="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab5_1_1_1_2" style="text-align:center;vertical-align:top;">№ of participants (studies) Follow up</th><th id="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab5_1_1_1_3" style="text-align:center;vertical-align:top;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab5_1_1_1_4" style="text-align:center;vertical-align:top;">Relative effect (95% CI)</th><th id="hd_h_niceng219er4.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:top;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er4.tab5_1_1_1_5" id="hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk with Colchicine subgroup</th><th headers="hd_h_niceng219er4.tab5_1_1_1_5" id="hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk difference with NSAIDs</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Joint pain scores (change score) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>105</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean 0.96</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.06 higher (0.28 lower to 0.4 higher)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Complete pain resolution - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.01 (0.88 to 1.18)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">667 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">7 more per 1,000 (80 fewer to 120 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Complete pain resolution – Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.02 (0.91 to 1.15)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">747 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">15 more per 1000 (67 fewer to 112 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Joint swelling scores - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>105</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean 0.73</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.04 higher (0.19 lower to 0.27 higher)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Patient assessment of global treatment response (completely/much better) n - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.06 (0.91 to 1.24)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">632 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">38 more per 1,000 (57 fewer to 152 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Patient assessment of global treatment response (completely/much better) n – Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.00 (0.91 to 1.11)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">822 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0 fewer per 1,000 (74 fewer to 90 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (vomiting) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>105</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.96(0.18 to 20.99)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">18 more per 1000 (from 16 fewer to 384 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (nausea and/or vomiting) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.72 (0.43 to 1.20)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">172 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">48 fewer per 1000 (98 fewer to 34 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (diarrhoea) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>449</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.47 (0.33 to 0.68)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">305 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">162 fewer per 1000 (205 fewer to 98 fewer)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (dyspepsia) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.02 (0.57 to 1.83)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">115 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2 more per 1000 (49 fewer to 95 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (abdominal pain) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.02 (0.53 to 1.98)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">92 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2 more per 1000 (43 fewer to 90 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (constipation) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.46 (0.31 to 0.67)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">385 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">208 fewer per 1000 (266 fewer to 127 fewer)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (nausea and/or vomiting) - Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.43 (0.46 to 4.43)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">29 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">12 more per 1000 (16 fewer to 99 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (dyspepsia) - Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.66 (0.71 to 3.91)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">46 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">30 more per 1000 (13 fewer to 134 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (abdominal pain) - Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.51 (0.16 to 1.67)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">46 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>23 fewer per 1000</p>
|
|
<p>(39 fewer to 31 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (constipation) - Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.54 (0.56 to 4.22)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">34 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19 more per 1000 (15 fewer to 111 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Adverse events-gastrointestinal (diarrhoea) - Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.51 (0.18 to 1.47)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">57 per 1,000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>28 fewer per 1000</p>
|
|
<p>(47 fewer to 27 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Consultation re-attendance for gout during 4-week follow-up - Emergency department – Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Peto OR 1.02 (0.06 to 16.23)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">6 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0 fewer per 1,000 (5 fewer to 80 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Consultation re-attendance for gout during 4-week follow-up - GP – Medium-term (2 to 6 weeks)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>344</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.68 (0.44 to 1.07)</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">224 per 1000</td><td headers="hd_h_niceng219er4.tab5_1_1_1_5 hd_h_niceng219er4.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">72 fewer per 1000 (126 fewer to 16 more)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er4.tab5_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng219er4.tab5_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs. Established MIDs used for VAS continuous scale - improvements of ≥ 10 points on a 1-100 scale; For dichotomous outcomes MIDs were taken to be RRs of 0.8 and 1.25. For continuous outcomes 0.5 × baseline SD was calculated: joint pain scores: 0.435; joint swelling: 0.98.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab6"><div id="niceng219er4.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: IL-1 inhibitors versus corticosteroids</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab6_1_1_1_1" style="text-align:center;vertical-align:top;">Outcomes</th><th id="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab6_1_1_1_2" style="text-align:center;vertical-align:top;">No of participants (studies) Follow up</th><th id="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab6_1_1_1_3" style="text-align:center;vertical-align:top;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab6_1_1_1_4" style="text-align:center;vertical-align:top;">Relative effect (95% CI)</th><th id="hd_h_niceng219er4.tab6_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:top;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er4.tab6_1_1_1_5" id="hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk with corticosteroids</th><th headers="hd_h_niceng219er4.tab6_1_1_1_5" id="hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk difference with Il-1 inhibitors</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Health related quality of life SF-36 - Physical Component - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>85</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean 41.9</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 6.4 higher (2.37 higher to 10.43 higher)</td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">SF-36 Physical component – long-term (more than 6 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>85</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">The mean SF-36 Physical component - long more than 6 weeks was 47.1</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 5.7 higher (1.88 higher to 9.52 higher)</td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">SF-36 - Mental component – long-term (more than 6 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>85</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean 49.1</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 4.2 higher (0.22 higher to 8.18 higher)</td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Pain: 100-mm visual analogue scale - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>454</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean 35.7</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 10.56 lower (15.26 lower to 5.87 lower)</td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Pain 100-mm VAS % change Scale from: 0 to 100 follow up: mean 2 weeks</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>194</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>d</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean −57.1</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 10.32 lower (17.25 lower to 3.38 lower)</td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Joint swelling - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>454</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 1.58 (1.09 to 2.31)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not provided</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Could not be estimated<sup>c</sup></td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Joint tenderness - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>454</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>a</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 2.16 (1.47 to 3.18)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not provided</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Could not be estimated<sup>c</sup></td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Patient global assessment - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>454</p>
|
|
<p>(2 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>a</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 1.98 (1.39 to 2.83)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Not provided</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Could not be estimated<sup>c</sup></td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Participant global assessment of response to treatment: good or excellent - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>83</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.67 (1.29 to 2.17)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">554 per 1000</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">371 more per 1000 (161 more to 648 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Any adverse event-short -term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>539</p>
|
|
<p>(3 RCTs)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.20 (1.03 to 1.39)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">507 per 1000</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">101 more per 1000 (15 more to 198 more)</td></tr><tr><td headers="hd_h_niceng219er4.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Any adverse event-long-term >6 weeks</td><td headers="hd_h_niceng219er4.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<p>109</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er4.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>b</sup></td><td headers="hd_h_niceng219er4.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.94 (0.59 to 1.49)</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">407 per 1000</td><td headers="hd_h_niceng219er4.tab6_1_1_1_5 hd_h_niceng219er4.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">24 fewer per 1000 (167 fewer to 200 more)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er4.tab6_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng219er4.tab6_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.Established MIDs for SF-36 physical/mental- 3.75; for VAS continuous scale - improvements of ≥ 10 points on a 1-100 scale; GRADE default MIDs used for all other outcomes. For dichotomous outcomes MIDs were taken to be RRs of 0.8 and 1.25.. Calculated MIDs for gout flares: 1, 2 and 3 were: 9.1, 10.3 and 5.9;</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng219er4.tab6_3"><p class="no_margin">Absolute effect could not be estimated because studies only reported OR and did not report means separately for intervention and control arms. Inverse variance analysis method was used.</p></div></dd></dl><dl class="bkr_refwrap"><dt>d</dt><dd><div id="niceng219er4.tab6_4"><p class="no_margin">I<sup>2</sup>= 79%, p=0.03</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab7"><div id="niceng219er4.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: ice plus prednisone and colchicine versus prednisone and colchicine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab7_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab7_1_1_1_1" style="text-align:center;vertical-align:top;">Outcomes</th><th id="hd_h_niceng219er4.tab7_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab7_1_1_1_2" style="text-align:center;vertical-align:top;">No of participants (studies) Follow up</th><th id="hd_h_niceng219er4.tab7_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab7_1_1_1_3" style="text-align:center;vertical-align:top;">Certainty of the evidence (GRADE)</th><th id="hd_h_niceng219er4.tab7_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er4.tab7_1_1_1_4" style="text-align:center;vertical-align:top;">Relative effect (95% CI)</th><th id="hd_h_niceng219er4.tab7_1_1_1_5" colspan="2" rowspan="1" style="text-align:center;vertical-align:top;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er4.tab7_1_1_1_5" id="hd_h_niceng219er4.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk with corticosteroids and colchicine</th><th headers="hd_h_niceng219er4.tab7_1_1_1_5" id="hd_h_niceng219er4.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Risk difference with Ice and corticosteroids and colchicine</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Pain (VAS 0-10) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
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<p>19</p>
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<p>(1 RCT)</p>
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</td><td headers="hd_h_niceng219er4.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab7_1_1_1_5 hd_h_niceng219er4.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean 4.74</td><td headers="hd_h_niceng219er4.tab7_1_1_1_5 hd_h_niceng219er4.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 3.94 lower (6.02 lower to 1.86 lower)</td></tr><tr><td headers="hd_h_niceng219er4.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Joint circumference (joint swelling) (cm) - Short-term (up to 2 weeks)</td><td headers="hd_h_niceng219er4.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
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<p>19</p>
|
|
<p>(1 RCT)</p>
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|
</td><td headers="hd_h_niceng219er4.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW<sup>a</sup><sup>,</sup><sup>b</sup></td><td headers="hd_h_niceng219er4.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng219er4.tab7_1_1_1_5 hd_h_niceng219er4.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">mean 33.4 (cm)</td><td headers="hd_h_niceng219er4.tab7_1_1_1_5 hd_h_niceng219er4.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MD 0.9 lower (9.45 lower to 7.65 higher)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er4.tab7_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng219er4.tab7_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs. Established MIDs VAS continuous scale - improvements of ≥ 10 points on a 1-100 scale; GRADE default MIDs used for all other outcomes. For dichotomous outcomes MIDs were taken to be RRs of 0.8 and 1.25. For continuous outcomes 0.5 × baseline SD was calculated, joint circumference: no baseline values reported so the control group SD was used:5.13.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab8"><div id="niceng219er4.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Health economic evidence profile: naproxen versus low-dose colchicine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng219er4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_niceng219er4.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_niceng219er4.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_niceng219er4.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_niceng219er4.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental effects</th><th id="hd_h_niceng219er4.tab8_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_niceng219er4.tab8_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Roddy 2020<a class="bibr" href="#niceng219er4.s1.1.ref47" rid="niceng219er4.s1.1.ref47"><sup>47</sup></a> (England)</td><td headers="hd_h_niceng219er4.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup>(a)</sup></td><td headers="hd_h_niceng219er4.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations<sup>(b)</sup></td><td headers="hd_h_niceng219er4.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Within-RCT analysis (Open-label randomised pragramtic trial [CONTACT] comparing naproxen and low-dose colchicine for the treatment of gout flares in primary care, Roddy 2020<a class="bibr" href="#niceng219er4.s1.1.ref47" rid="niceng219er4.s1.1.ref47"><sup>47</sup></a>)</div></li><li class="half_rhythm"><div>Cost-utility analysis (QALYs)</div></li><li class="half_rhythm"><div>Population: People 18 years and over consulting for a current gout flare.</div></li><li class="half_rhythm"><div>Comparators: Naproxen versus low-dose colchicine</div></li></ul>
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Time horizon: 4 weeks</td><td headers="hd_h_niceng219er4.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Saves £5.74<sup>(c)</sup></td><td headers="hd_h_niceng219er4.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.0004 QALYs<sup>(d)</sup></td><td headers="hd_h_niceng219er4.tab8_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen dominates (less costly and more effective)</td><td headers="hd_h_niceng219er4.tab8_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probability naproxen cost effective (£20K threshold): 80%</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations: ICER= incremental cost-effectiveness ratio; QALY= quality-adjusted life years; RCT= randomised controlled trial</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng219er4.tab8_1"><p class="no_margin">The analysis uses EQ-5D-5L and so is not in line with the NICE reference case with preference for the EQ-5D-3L.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng219er4.tab8_2"><p class="no_margin">Unit costs taken from ‘standard UK sources’ but no references provided, cost of PPIs not included for naproxen, short time horizon.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng219er4.tab8_3"><p class="no_margin">2015/16 costs. Cost components incorporated: Drug costs, GP costs, nurse costs, Emergency GP costs, A&E costs, intervention costs.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(d)</dt><dd><div id="niceng219er4.tab8_4"><p class="no_margin">QALYs adjusted for baseline values (both ‘QALYs’ and ‘QALYs adjusted for baseline values’ were reported in the study)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab9"><div id="niceng219er4.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">UK cost of NSAIDs for people without CKD</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug<sup>(a)</sup></th><th id="hd_h_niceng219er4.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er4.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er4.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th><th id="hd_h_niceng219er4.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per flare<sup>(b)</sup></th></tr></thead><tbody><tr><th headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_h_niceng219er4.tab9_1_1_1_2 hd_h_niceng219er4.tab9_1_1_1_3 hd_h_niceng219er4.tab9_1_1_1_4 hd_h_niceng219er4.tab9_1_1_1_5" id="hd_b_niceng219er4.tab9_1_1_1_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
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<i>
|
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<u>Celecoxib</u>
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</i>
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</th></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Celecoxib 100mg capsules</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">200mg – 400mg</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07 - £0.13</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.21 - £1.30</td></tr><tr><th headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_h_niceng219er4.tab9_1_1_1_2 hd_h_niceng219er4.tab9_1_1_1_3 hd_h_niceng219er4.tab9_1_1_1_4 hd_h_niceng219er4.tab9_1_1_1_5" id="hd_b_niceng219er4.tab9_1_1_3_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Diclofenac sodium</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 50mg gastro-resistant tablets / Misoprostol 200microgram tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.20</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:middle;">150mg daily</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.60</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.80 - £6.00</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 50mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45 - £1.50</td></tr><tr><th headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_h_niceng219er4.tab9_1_1_1_2 hd_h_niceng219er4.tab9_1_1_1_3 hd_h_niceng219er4.tab9_1_1_1_4 hd_h_niceng219er4.tab9_1_1_1_5" id="hd_b_niceng219er4.tab9_1_1_6_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Etoricoxib</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 60mg tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_6_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_6_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">120mg daily</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_6_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.20</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_6_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.60 - £2.00</td></tr><tr><th headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_h_niceng219er4.tab9_1_1_1_2 hd_h_niceng219er4.tab9_1_1_1_3 hd_h_niceng219er4.tab9_1_1_1_4 hd_h_niceng219er4.tab9_1_1_1_5" id="hd_b_niceng219er4.tab9_1_1_8_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Ibuprofen</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 400mg tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.2g daily</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.21</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.63 - £2.10</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 600mg tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.8g daily</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.51 - £1.70</td></tr><tr><th headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_h_niceng219er4.tab9_1_1_1_2 hd_h_niceng219er4.tab9_1_1_1_3 hd_h_niceng219er4.tab9_1_1_1_4 hd_h_niceng219er4.tab9_1_1_1_5" id="hd_b_niceng219er4.tab9_1_1_11_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Indomethacin</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indomethacin 50mg capsules</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">150mg – 200mg daily</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18 - £0.24</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.54 - £2.90</td></tr><tr><th headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_h_niceng219er4.tab9_1_1_1_2 hd_h_niceng219er4.tab9_1_1_1_3 hd_h_niceng219er4.tab9_1_1_1_4 hd_h_niceng219er4.tab9_1_1_1_5" id="hd_b_niceng219er4.tab9_1_1_13_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Meloxicam</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="4" colspan="1" style="text-align:center;vertical-align:middle;">7.5mg – 15mg daily</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.55 - £8.50</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.48 - £1.60</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.55 - £8.50</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.33 - £1.10</td></tr><tr><th headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_h_niceng219er4.tab9_1_1_1_2 hd_h_niceng219er4.tab9_1_1_1_3 hd_h_niceng219er4.tab9_1_1_1_4 hd_h_niceng219er4.tab9_1_1_1_5" id="hd_b_niceng219er4.tab9_1_1_18_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Naproxen</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg effervescent tablets sugar free</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89</td><td headers="hd_h_niceng219er4.tab9_1_1_1_3 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="6" colspan="1" style="text-align:center;vertical-align:middle;">750mg – 1500mg daily</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£8.66</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£25.98 - £28.90</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.14</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.41</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.23 - £4.10</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.48 - £1.60</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg/5ml oral suspension</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.35</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£4.05 - £13.50</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.51</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.53 - £5.10</td></tr><tr><td headers="hd_h_niceng219er4.tab9_1_1_1_1 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg tablets</td><td headers="hd_h_niceng219er4.tab9_1_1_1_2 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab9_1_1_1_4 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.19</td><td headers="hd_h_niceng219er4.tab9_1_1_1_5 hd_b_niceng219er4.tab9_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.57 - £1.90</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Sources:</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng219er4.tab9_1"><p class="no_margin">British National Formulary, Accessed October 2021<a class="bibr" href="#niceng219er4.s1.1.ref9" rid="niceng219er4.s1.1.ref9"><sup>9</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Dosing:</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng219er4.tab9_2"><p class="no_margin">Assuming people receive medication for 3 – 10 days</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab10"><div id="niceng219er4.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">UK cost of NSAIDs for people with CKD stage 3</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug<sup>(a)</sup></th><th id="hd_h_niceng219er4.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er4.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er4.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th><th id="hd_h_niceng219er4.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per flare<sup>(b)</sup></th></tr></thead><tbody><tr><th headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_h_niceng219er4.tab10_1_1_1_2 hd_h_niceng219er4.tab10_1_1_1_3 hd_h_niceng219er4.tab10_1_1_1_4 hd_h_niceng219er4.tab10_1_1_1_5" id="hd_b_niceng219er4.tab10_1_1_1_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Celecoxib</u>
|
|
</i>
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|
</th></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Celecoxib 100mg capsules</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">100mg – 400mg</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03 - £0.13</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.09 - £1.30</td></tr><tr><th headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_h_niceng219er4.tab10_1_1_1_2 hd_h_niceng219er4.tab10_1_1_1_3 hd_h_niceng219er4.tab10_1_1_1_4 hd_h_niceng219er4.tab10_1_1_1_5" id="hd_b_niceng219er4.tab10_1_1_3_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Diclofenac sodium</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 25mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="5" colspan="1" style="text-align:center;vertical-align:middle;">75 – 150mg daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.54 - £1.80</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 75mg gastro-resistant / Misoprostol 200microgram tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.26</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.79</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.37 - £7.90</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 75mg gastro-resistant modified-release capsules</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.14</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.43</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.29 - £4.30</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 75mg modified-release capsules</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.20</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.61</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.83 - £6.10</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 75mg modified-release tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.31</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.94</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.82 - £9.40</td></tr><tr><th headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_h_niceng219er4.tab10_1_1_1_2 hd_h_niceng219er4.tab10_1_1_1_3 hd_h_niceng219er4.tab10_1_1_1_4 hd_h_niceng219er4.tab10_1_1_1_5" id="hd_b_niceng219er4.tab10_1_1_9_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
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<u>Etoricoxib</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 60mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">60mg – 120mg daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10 – £0.20</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.30 - £2.00</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 90mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.09</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">90mg daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.09</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_9_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.27 - £0.90</td></tr><tr><th headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_h_niceng219er4.tab10_1_1_1_2 hd_h_niceng219er4.tab10_1_1_1_3 hd_h_niceng219er4.tab10_1_1_1_4 hd_h_niceng219er4.tab10_1_1_1_5" id="hd_b_niceng219er4.tab10_1_1_12_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Ibuprofen</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 200mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.04</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">600mg daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.44 - £1.50</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 400mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.2g daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.21</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.63 - £2.10</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 600mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.8g daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_12_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.51 - £1.70</td></tr><tr><th headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_h_niceng219er4.tab10_1_1_1_2 hd_h_niceng219er4.tab10_1_1_1_3 hd_h_niceng219er4.tab10_1_1_1_4 hd_h_niceng219er4.tab10_1_1_1_5" id="hd_b_niceng219er4.tab10_1_1_16_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Indomethacin</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indomethacin 50mg capsules</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">150mg – 200mg daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18 - £0.24</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.54 - £2.40</td></tr><tr><th headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_h_niceng219er4.tab10_1_1_1_2 hd_h_niceng219er4.tab10_1_1_1_3 hd_h_niceng219er4.tab10_1_1_1_4 hd_h_niceng219er4.tab10_1_1_1_5" id="hd_b_niceng219er4.tab10_1_1_18_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Meloxicam</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="4" colspan="1" style="text-align:center;vertical-align:middle;">7.5mg – 15mg daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.55 - £8.50</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.48 - £1.60</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.55 - £8.50</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_18_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.33 - £1.10</td></tr><tr><th headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_h_niceng219er4.tab10_1_1_1_2 hd_h_niceng219er4.tab10_1_1_1_3 hd_h_niceng219er4.tab10_1_1_1_4 hd_h_niceng219er4.tab10_1_1_1_5" id="hd_b_niceng219er4.tab10_1_1_23_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Naproxen</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg effervescent tablets sugar free</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89</td><td headers="hd_h_niceng219er4.tab10_1_1_1_3 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="6" colspan="1" style="text-align:center;vertical-align:middle;">500mg – 1000mg daily</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£5.78 – £11.56</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£17.34 - £115.60</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.08</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16 – £0.32</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.48 - £3.20</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10 – £0.20</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.20 - £2.00</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg/5ml oral suspension</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.90 – £1.80</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.70 - £18.00</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17 - £0.34</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.51 - £3.40</td></tr><tr><td headers="hd_h_niceng219er4.tab10_1_1_1_1 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg tablets</td><td headers="hd_h_niceng219er4.tab10_1_1_1_2 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab10_1_1_1_4 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06 - £0.12</td><td headers="hd_h_niceng219er4.tab10_1_1_1_5 hd_b_niceng219er4.tab10_1_1_23_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18 - £1.20</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Sources:</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng219er4.tab10_1"><p class="no_margin">British National Formulary, Accessed October 2021<a class="bibr" href="#niceng219er4.s1.1.ref9" rid="niceng219er4.s1.1.ref9"><sup>9</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Dosing:</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng219er4.tab10_2"><p class="no_margin">Assuming people receive medication for 3 – 10 days</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab11"><div id="niceng219er4.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">UK cost of NSAIDs for people with CKD stage 4-5</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug<sup>(a)</sup></th><th id="hd_h_niceng219er4.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er4.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er4.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th><th id="hd_h_niceng219er4.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per flare<sup>(b)</sup></th></tr></thead><tbody><tr><th headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_h_niceng219er4.tab11_1_1_1_2 hd_h_niceng219er4.tab11_1_1_1_3 hd_h_niceng219er4.tab11_1_1_1_4 hd_h_niceng219er4.tab11_1_1_1_5" id="hd_b_niceng219er4.tab11_1_1_1_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
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<u>Celecoxib</u>
|
|
</i>
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|
</th></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Celecoxib 100mg capsules</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">100mg – 200mg</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03 - £0.06</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.09 - £0.60</td></tr><tr><th headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_h_niceng219er4.tab11_1_1_1_2 hd_h_niceng219er4.tab11_1_1_1_3 hd_h_niceng219er4.tab11_1_1_1_4 hd_h_niceng219er4.tab11_1_1_1_5" id="hd_b_niceng219er4.tab11_1_1_3_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
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<u>Diclofenac sodium</u>
|
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</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 25mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">75mg daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.54 - £1.80</td></tr><tr><th headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_h_niceng219er4.tab11_1_1_1_2 hd_h_niceng219er4.tab11_1_1_1_3 hd_h_niceng219er4.tab11_1_1_1_4 hd_h_niceng219er4.tab11_1_1_1_5" id="hd_b_niceng219er4.tab11_1_1_5_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Etoricoxib</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 30mg tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.22</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">30mg daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.22</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.66 - £2.20</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 60mg tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">60mg daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.30 - £1.00</td></tr><tr><th headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_h_niceng219er4.tab11_1_1_1_2 hd_h_niceng219er4.tab11_1_1_1_3 hd_h_niceng219er4.tab11_1_1_1_4 hd_h_niceng219er4.tab11_1_1_1_5" id="hd_b_niceng219er4.tab11_1_1_8_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Ibuprofen</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 200mg tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.04</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">600mg daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.44 - £1.50</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 400mg tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.2g daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.21</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.63 - £2.10</td></tr><tr><th headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_h_niceng219er4.tab11_1_1_1_2 hd_h_niceng219er4.tab11_1_1_1_3 hd_h_niceng219er4.tab11_1_1_1_4 hd_h_niceng219er4.tab11_1_1_1_5" id="hd_b_niceng219er4.tab11_1_1_11_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
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<i>
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|
<u>Indomethacin</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indomethacin 25mg capsules</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">75mg – 100mg daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15 - £0.20</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45 - £2.00</td></tr><tr><th headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_h_niceng219er4.tab11_1_1_1_2 hd_h_niceng219er4.tab11_1_1_1_3 hd_h_niceng219er4.tab11_1_1_1_4 hd_h_niceng219er4.tab11_1_1_1_5" id="hd_b_niceng219er4.tab11_1_1_13_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Meloxicam</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:middle;">7.5mg daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.55 - £8.50</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_13_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.33 - £1.10</td></tr><tr><th headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_h_niceng219er4.tab11_1_1_1_2 hd_h_niceng219er4.tab11_1_1_1_3 hd_h_niceng219er4.tab11_1_1_1_4 hd_h_niceng219er4.tab11_1_1_1_5" id="hd_b_niceng219er4.tab11_1_1_16_1" colspan="5" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Naproxen</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg effervescent tablets sugar free</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89</td><td headers="hd_h_niceng219er4.tab11_1_1_1_3 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="6" colspan="1" style="text-align:center;vertical-align:middle;">250mg – 750mg daily</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89 – £8.67</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£8.67 - £86.70</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.08</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.08 – £0.24</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.24 - £2.40</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05 – £0.15</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15 - £1.50</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg/5ml oral suspension</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45 – £1.35</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.35 - £13.50</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg gastro-resistant tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.36 - £1.20</td></tr><tr><td headers="hd_h_niceng219er4.tab11_1_1_1_1 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg tablets</td><td headers="hd_h_niceng219er4.tab11_1_1_1_2 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab11_1_1_1_4 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab11_1_1_1_5 hd_b_niceng219er4.tab11_1_1_16_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18 - £0.60</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Sources:</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng219er4.tab11_1"><p class="no_margin">British National Formulary, Accessed October 2021<a class="bibr" href="#niceng219er4.s1.1.ref9" rid="niceng219er4.s1.1.ref9"><sup>9</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Dosing:</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng219er4.tab11_2"><p class="no_margin">Assuming people receive medication for 3 – 10 days</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab12"><div id="niceng219er4.tab12" class="table"><h3><span class="label">Table 12</span><span class="title">UK cost of Colchicine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab12_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug</th><th id="hd_h_niceng219er4.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er4.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er4.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th><th id="hd_h_niceng219er4.tab12_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per flare<sup>(a)</sup></th></tr></thead><tbody><tr><td headers="hd_h_niceng219er4.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Colchicine 500microgram tablets</td><td headers="hd_h_niceng219er4.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er4.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1mg – 2mg daily</td><td headers="hd_h_niceng219er4.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10 - £0.20</td><td headers="hd_h_niceng219er4.tab12_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.30 - £2.00</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Drug Tariff, Accessed October 2021<a class="bibr" href="#niceng219er4.s1.1.ref43" rid="niceng219er4.s1.1.ref43"><sup>43</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng219er4.tab12_1"><p class="no_margin">Assuming people receive medication for 3 days</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab13"><div id="niceng219er4.tab13" class="table"><h3><span class="label">Table 13</span><span class="title">UK cost of Corticosteroids</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab13/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab13_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug</th><th id="hd_h_niceng219er4.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er4.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dosage</th></tr></thead><tbody><tr><th headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_h_niceng219er4.tab13_1_1_1_2 hd_h_niceng219er4.tab13_1_1_1_3" id="hd_b_niceng219er4.tab13_1_1_1_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
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|
<u>Methylprednisolone</u>
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|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methylprednisolone 40mg/1ml / Lidocaine 10mg/1ml (1%) suspension for injection vials</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3.94</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methylprednisolone 80mg/2ml / Lidocaine 20mg/2ml (1%) suspension for injection vials</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£7.06</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methylprednisolone acetate 120mg/3ml suspension for injection vials</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£8.96</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methylprednisolone acetate 40mg/1ml suspension for injection vials</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3.44</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Methylprednisolone acetate 80mg/2ml suspension for injection vials</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£6.18</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr><tr><th headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_h_niceng219er4.tab13_1_1_1_2 hd_h_niceng219er4.tab13_1_1_1_3" id="hd_b_niceng219er4.tab13_1_1_7_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Prednisolone</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prednisolone 5mg tablets</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30mg daily (costing £0.18 per day)</td></tr><tr><th headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_h_niceng219er4.tab13_1_1_1_2 hd_h_niceng219er4.tab13_1_1_1_3" id="hd_b_niceng219er4.tab13_1_1_9_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
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<u>Triamcinolone</u>
|
|
</i>
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|
</th></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Triamcinolone acetonide 40mg/1ml suspension for injection vials</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.49</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection on initiation or titration of ULT</td></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Triamcinolone acetonide 50mg/5ml suspension for injection vials</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3.63</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr><tr><td headers="hd_h_niceng219er4.tab13_1_1_1_1 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Triamcinolone hexacetonide 20 mg/1ml suspension for injection ampules</td><td headers="hd_h_niceng219er4.tab13_1_1_1_2 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£12.00</td><td headers="hd_h_niceng219er4.tab13_1_1_1_3 hd_b_niceng219er4.tab13_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Drug Tariff, Accessed October 2021<a class="bibr" href="#niceng219er4.s1.1.ref43" rid="niceng219er4.s1.1.ref43"><sup>43</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab14"><div id="niceng219er4.tab14" class="table"><h3><span class="label">Table 14</span><span class="title">UK cost of proton pump inhibitors (PPI’s)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab14/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab14_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug</th><th id="hd_h_niceng219er4.tab14_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er4.tab14_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dosage</th></tr></thead><tbody><tr><th headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_h_niceng219er4.tab14_1_1_1_2 hd_h_niceng219er4.tab14_1_1_1_3" id="hd_b_niceng219er4.tab14_1_1_1_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Omeprazole</th></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Omeprazole 10mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.33</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Omeprazole 20mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.49</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Omeprazole 40mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.98</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><th headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_h_niceng219er4.tab14_1_1_1_2 hd_h_niceng219er4.tab14_1_1_1_3" id="hd_b_niceng219er4.tab14_1_1_5_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Esomeprazole</th></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Esomeprazole 20mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.15</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Esomeprazole 40mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.15</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><th headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_h_niceng219er4.tab14_1_1_1_2 hd_h_niceng219er4.tab14_1_1_1_3" id="hd_b_niceng219er4.tab14_1_1_8_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Lansoprazole</th></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lansoprazole 15mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.13</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lansoprazole 30mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.18</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><th headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_h_niceng219er4.tab14_1_1_1_2 hd_h_niceng219er4.tab14_1_1_1_3" id="hd_b_niceng219er4.tab14_1_1_11_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Rabeprazole</th></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rabeprazole 10mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rabeprazole 20mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><th headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_h_niceng219er4.tab14_1_1_1_2 hd_h_niceng219er4.tab14_1_1_1_3" id="hd_b_niceng219er4.tab14_1_1_14_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Pantoprazole</th></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pantoprazole 20mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr><tr><td headers="hd_h_niceng219er4.tab14_1_1_1_1 hd_b_niceng219er4.tab14_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pantoprazole 40mg tablets</td><td headers="hd_h_niceng219er4.tab14_1_1_1_2 hd_b_niceng219er4.tab14_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er4.tab14_1_1_1_3 hd_b_niceng219er4.tab14_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 tablet per day</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: British National Formulary, Accessed October 2021<a class="bibr" href="#niceng219er4.s1.1.ref9" rid="niceng219er4.s1.1.ref9"><sup>9</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Note: PPI’s are a gastro-resistant tablet which can be prescribed in conjunction with NSAIDs and oral corticosteroids.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er4tab15"><div id="niceng219er4.tab15" class="table"><h3><span class="label">Table 15</span><span class="title">UK cost of IL-1 Inhibitors</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583527/table/niceng219er4.tab15/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er4.tab15_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er4.tab15_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug</th><th id="hd_h_niceng219er4.tab15_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er4.tab15_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dosage</th></tr></thead><tbody><tr><th headers="hd_h_niceng219er4.tab15_1_1_1_1 hd_h_niceng219er4.tab15_1_1_1_2 hd_h_niceng219er4.tab15_1_1_1_3" id="hd_b_niceng219er4.tab15_1_1_1_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
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<i>
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<u>Anakinra</u>
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</i>
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</th></tr><tr><td headers="hd_h_niceng219er4.tab15_1_1_1_1 hd_b_niceng219er4.tab15_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anakinra 100mg /0.67ml solution for injection pre-filled syringes</td><td headers="hd_h_niceng219er4.tab15_1_1_1_2 hd_b_niceng219er4.tab15_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£26.23</td><td headers="hd_h_niceng219er4.tab15_1_1_1_3 hd_b_niceng219er4.tab15_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3-5 injections per gout flare</td></tr><tr><th headers="hd_h_niceng219er4.tab15_1_1_1_1 hd_h_niceng219er4.tab15_1_1_1_2 hd_h_niceng219er4.tab15_1_1_1_3" id="hd_b_niceng219er4.tab15_1_1_3_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
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<i>
|
|
<u>Canakinumab</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er4.tab15_1_1_1_1 hd_b_niceng219er4.tab15_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Canakinumab 150mg per 1ml solution for injection vials</td><td headers="hd_h_niceng219er4.tab15_1_1_1_2 hd_b_niceng219er4.tab15_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£9,928</td><td headers="hd_h_niceng219er4.tab15_1_1_1_3 hd_b_niceng219er4.tab15_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection per gout flare</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: British National Formulary, Accessed October 2021<a class="bibr" href="#niceng219er4.s1.1.ref9" rid="niceng219er4.s1.1.ref9"><sup>9</sup></a></p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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