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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-niceng219er8-lrg.png" alt="Cover of Evidence reviews for colchicine, NSAIDs, corticosteroids and IL-1 inhibitors for the prevention of gout flares during the initiation or titration of urate-lowering therapy" /></a></div><div class="bkr_bib"><h1 id="_NBK586319_"><span itemprop="name">Evidence reviews for colchicine, NSAIDs, corticosteroids and IL-1 inhibitors for the prevention of gout flares during the initiation or titration of urate-lowering therapy</span></h1><div class="subtitle">Gout: diagnosis and management</div><p><b>Evidence review H</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="niceng219er8.s1"><h2 id="_niceng219er8_s1_">1. Prevention of gout flares during initiation or titration of urate-lowering therapies</h2><div id="niceng219er8.s1.1"><h3>1.1. Review question: In people with gout (including people with gout and chronic kidney disease), what is the clinical and cost effectiveness of colchicine, NSAIDs, corticosteroids and IL-1 inhibitors for the prevention of gout flares during the initiation or titration of urate-lowering therapy?</h3><div id="niceng219er8.s1.1.1"><h4>1.1.1. Introduction</h4><p>Long-term urate-lowering therapy (ULT) for gout aims to lower serum urate levels and prevent gout flares. However, ULT initiation and dose escalation commonly triggers gout flares in the first few months. ULT-induced flares are often perceived as indicating that ULT is not working, causing ULT to be stopped, and hence can contribute to poor uptake of and adherence to ULT. Prophylactic anti-inflammatory medications are often co-prescribed with ULT to prevent such flares.</p><p>The most commonly prescribed interventions to prevent flares when initiating ULT is colchicine. In people in whom colchicine is not tolerated, contraindicated or ineffective, non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids can be used. Interleukin-1 inhibitors are rarely used for prophylaxis in clinical practice, owing to their expense and the wide availability of other treatments. This evidence review will determine the clinical and cost effectiveness of anti-inflammatory medication to prevent gout flares when initiating ULT.</p></div><div id="niceng219er8.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng219er8.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er8tab1"><a href="/books/NBK586319/table/niceng219er8.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab1" rid-ob="figobniceng219er8tab1"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab1/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab1"><a href="/books/NBK586319/table/niceng219er8.tab1/?report=objectonly" target="object" rid-ob="figobniceng219er8tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng219er8.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="#niceng219er8.appa">Appendix A</a> and the <a href="/books/NBK586319/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="niceng219er8.s1.1.4"><h4>1.1.4. Effectiveness evidence</h4><div id="niceng219er8.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>A search was conducted for randomised trials comparing the clinical effectiveness of colchicine, NSAIDs, corticosteroids and IL-1 inhibitors for the prevention of flares during the initiation or titration of urate-lowering therapy for people with gout.</p><p>Three randomised controlled studies were included in the review<a class="bibr" href="#niceng219er8.s1.1.ref2" rid="niceng219er8.s1.1.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng219er8.s1.1.ref13" rid="niceng219er8.s1.1.ref13"><sup>13</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng219er8.s1.1.ref23" rid="niceng219er8.s1.1.ref23"><sup>23</sup></a> these are summarised in <a class="figpopup" href="/books/NBK586319/table/niceng219er8.tab2/?report=objectonly" target="object" rid-figpopup="figniceng219er8tab2" rid-ob="figobniceng219er8tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK586319/table/niceng219er8.tab3/?report=objectonly" target="object" rid-figpopup="figniceng219er8tab3" rid-ob="figobniceng219er8tab3">Table 3</a>).</p><p>The three included studies evaluated pharmacological interventions in people with gout who do not have chronic kidney disease. Two studies evaluated the use of colchicine for preventing gout flares during the initiation or titration of urate-lowering therapies. The third study evaluated the use of canakinumab (versus colchicine) for preventing gout flares during the initiation or titration of urate-lowering therapies.</p><p>Non-randomised studies were searched for, but none were found that adequately adjusted for key confounders and therefore were excluded from the review.</p><p>See also the study selection flow chart in <a href="#niceng219er8.appc">Appendix C</a>, study evidence tables in <a href="#niceng219er8.appd">Appendix D</a>, forest plots in <a href="#niceng219er8.appe">Appendix E</a> and GRADE tables in <a href="#niceng219er8.appf">Appendix F</a>.</p></div><div id="niceng219er8.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng219er8.appj">Appendix J</a>.</p></div></div><div id="niceng219er8.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="figniceng219er8tab2"><a href="/books/NBK586319/table/niceng219er8.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab2" rid-ob="figobniceng219er8tab2"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab2/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab2"><a href="/books/NBK586319/table/niceng219er8.tab2/?report=objectonly" target="object" rid-ob="figobniceng219er8tab2">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="#niceng219er8.appd">Appendix D</a> for full evidence tables.</p></div><div id="niceng219er8.s1.1.6"><h4>1.1.6. Summary of the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er8tab3"><a href="/books/NBK586319/table/niceng219er8.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab3" rid-ob="figobniceng219er8tab3"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab3/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: Colchicine (colchicine plus febuxostat 40mg) versus no treatment (febuxostat 40mg)." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab3"><a href="/books/NBK586319/table/niceng219er8.tab3/?report=objectonly" target="object" rid-ob="figobniceng219er8tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Colchicine (colchicine plus febuxostat 40mg) versus no treatment (febuxostat 40mg). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er8tab4"><a href="/books/NBK586319/table/niceng219er8.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab4" rid-ob="figobniceng219er8tab4"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab4/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: Colchicine (colchicine plus allopurinol) versus placebo (placebo plus allopurinol)." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab4"><a href="/books/NBK586319/table/niceng219er8.tab4/?report=objectonly" target="object" rid-ob="figobniceng219er8tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Colchicine (colchicine plus allopurinol) versus placebo (placebo plus allopurinol). </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er8tab5"><a href="/books/NBK586319/table/niceng219er8.tab5/?report=objectonly" target="object" title="Tale 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab5" rid-ob="figobniceng219er8tab5"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab5/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab5/?report=previmg" alt="Tale 5. Clinical evidence summary: Canakinumab (canakinumab plus allopurinol) versus colchicine (colchicine versus allopurinol)." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab5"><a href="/books/NBK586319/table/niceng219er8.tab5/?report=objectonly" target="object" rid-ob="figobniceng219er8tab5">Tale 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Canakinumab (canakinumab plus allopurinol) versus colchicine (colchicine versus allopurinol). </p></div></div><p>See <a href="#niceng219er8.appf">Appendix F</a> for full GRADE tables.</p></div><div id="niceng219er8.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng219er8.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng219er8.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>One economic study relating to this review question was identified but excluded due to a combination of limited applicability and methodological limitations<a class="bibr" href="#niceng219er8.s1.1.ref12" rid="niceng219er8.s1.1.ref12"><sup>12</sup></a>. This study is listed in <a href="#niceng219er8.appj">Appendix J</a>, with reasons for exclusion given.</p></div></div><div id="niceng219er8.s1.1.8"><h4>1.1.8. Economic model</h4><p>This area was not prioritised for new cost-effectiveness analysis.</p></div><div id="niceng219er8.s1.1.9"><h4>1.1.9. 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="figniceng219er8tab6"><a href="/books/NBK586319/table/niceng219er8.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab6" rid-ob="figobniceng219er8tab6"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab6/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab6/?report=previmg" alt="Table 6. UK cost of NSAIDs for people without CKD." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab6"><a href="/books/NBK586319/table/niceng219er8.tab6/?report=objectonly" target="object" rid-ob="figobniceng219er8tab6">Table 6</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="figniceng219er8tab7"><a href="/books/NBK586319/table/niceng219er8.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab7" rid-ob="figobniceng219er8tab7"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab7/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab7/?report=previmg" alt="Table 7. UK cost of NSAIDs for people with CKD stage 3." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab7"><a href="/books/NBK586319/table/niceng219er8.tab7/?report=objectonly" target="object" rid-ob="figobniceng219er8tab7">Table 7</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="figniceng219er8tab8"><a href="/books/NBK586319/table/niceng219er8.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab8" rid-ob="figobniceng219er8tab8"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab8/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab8/?report=previmg" alt="Table 8. UK cost of NSAIDs for people with CKD stage 4-5." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab8"><a href="/books/NBK586319/table/niceng219er8.tab8/?report=objectonly" target="object" rid-ob="figobniceng219er8tab8">Table 8</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="figniceng219er8tab9"><a href="/books/NBK586319/table/niceng219er8.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab9" rid-ob="figobniceng219er8tab9"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab9/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab9/?report=previmg" alt="Table 9. UK cost of Colchicine." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab9"><a href="/books/NBK586319/table/niceng219er8.tab9/?report=objectonly" target="object" rid-ob="figobniceng219er8tab9">Table 9</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="figniceng219er8tab10"><a href="/books/NBK586319/table/niceng219er8.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab10" rid-ob="figobniceng219er8tab10"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab10/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab10/?report=previmg" alt="Table 10. UK cost of Corticosteroids." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab10"><a href="/books/NBK586319/table/niceng219er8.tab10/?report=objectonly" target="object" rid-ob="figobniceng219er8tab10">Table 10</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="figniceng219er8tab11"><a href="/books/NBK586319/table/niceng219er8.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab11" rid-ob="figobniceng219er8tab11"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab11/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab11/?report=previmg" alt="Table 11. UK cost of proton pump inhibitors (PPI’s)." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab11"><a href="/books/NBK586319/table/niceng219er8.tab11/?report=objectonly" target="object" rid-ob="figobniceng219er8tab11">Table 11</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="figniceng219er8tab12"><a href="/books/NBK586319/table/niceng219er8.tab12/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er8tab12" rid-ob="figobniceng219er8tab12"><img class="small-thumb" src="/books/NBK586319/table/niceng219er8.tab12/?report=thumb" src-large="/books/NBK586319/table/niceng219er8.tab12/?report=previmg" alt="Table 12. UK cost of IL-1 Inhibitors." /></a><div class="icnblk_cntnt"><h4 id="niceng219er8.tab12"><a href="/books/NBK586319/table/niceng219er8.tab12/?report=objectonly" target="object" rid-ob="figobniceng219er8tab12">Table 12</a></h4><p class="float-caption no_bottom_margin">UK cost of IL-1 Inhibitors. </p></div></div></div><div id="niceng219er8.s1.1.10"><h4>1.1.10. Evidence statements</h4><div id="niceng219er8.s1.1.10.1"><h5>Economic</h5><ul><li class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div><div id="niceng219er8.s1.1.11"><h4>1.1.11. The committee’s discussion and interpretation of the evidence</h4><div id="niceng219er8.s1.1.11.1"><h5>1.1.11.1. 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, frequency of flares, patient global assessment of treatment success, serum urate levels, adverse events (cardiovascular, renal and gastrointestinal), admission (hospital and A&E/urgent care) and discontinuation of ULT. As the focus of the question is drug intervention to prevent flares when starting or titrating ULT the committee agreed frequency of flares outcome was of particular interest.</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><p>Outcome data was available only for frequency of flares and adverse events (cardiovascular, renal and gastrointestinal). Outcome data was reported for long-term outcomes only (3-6 months).</p></div><div id="niceng219er8.s1.1.11.2"><h5>1.1.11.2. The quality of the evidence</h5><p>Three randomised controlled trials (RCTs) evaluating pharmacological prophylaxis in people with gout when initiating ULTs were included in this review. None of the studies evaluated pharmacological interventions in people with chronic kidney disease.</p><p>The three studies evaluated three comparisons; all these comparisons included a colchicine arm. Colchicine (plus febuxostat) was compared to no treatment (febuxostat only), placebo and canakinumab (an IL-1 inhibitor).</p><p>For colchicine (plus febuxostat) compared to no treatment (febuxostat only) frequency of flares and adverse events (gastrointestinal, renal and cardiovascular) were reported. The quality of this evidence ranged from low to moderate due to imprecision. The committee noted that this study used a 40mg dose of febuxostat but in the UK licensed doses are 80mg and 120mg, although the committee reported that in clinical practice a person might sometimes be started on 40mg or 80mg. This may be the case where people have moderate hepatic impairment or where there is a high risk of gout flares during initiation of therapy. As a lower dose of ULT was used precipitation of flares may be less likely and the study underestimated the benefit of colchicine as prophylaxis. However, in clinical practice a slow increase in ULT may also result in fewer flares initially. The committee noted the uncertainty in the evidence results.</p><p>For the comparison of canakinumab versus colchicine, frequency of flares (people experiencing ≥1 flares) and adverse events (gastrointestinal) were reported. The quality of this evidence ranged from very low to moderate due to risk of bias (possible selection bias, as the sequence generation and allocation concealment were not detailed) and imprecision. For the comparison of colchicine versus placebo, frequency of flares (people experiencing 1 flare and people experiencing >1 flares) and adverse events (gastrointestinal) were reported in a small study (n=43). The quality of this evidence ranged from low to moderate due to risk of bias (possible selection bias, as the sequence generation and allocation concealment were not stated) and imprecision.</p><p>Overall, the amount of evidence for Colchicine was low (based on three small RCTs) and the evidence had limitations. Furthermore, the studies were all followed-up between 3-6 months, and therefore showed indirectness for the initiation of therapy.</p><p>No evidence was found for NSAID or corticosteroid pharmacological prophylaxis.</p></div><div id="niceng219er8.s1.1.11.3"><h5>1.1.11.3. Benefits and harms</h5><p>The evidence showed a clinical benefit of colchicine when compared with placebo and no treatment for reducing the frequency of gout flares when initiating ULTs. When colchicine was compared with placebo there were gastrointestinal adverse events indicating clinical harm, although there was no clinical difference in terms of adverse events (gastrointestinal, renal and cardiovascular) when colchicine was compared to no treatment. The committee agreed gastrointestinal adverse events are common in clinical practice in people taking colchicine.</p><p>There were no studies evaluating outcomes during the initial titration of ULT e.g. less than 3 months. However, <a href="https://guidelines.rcplondon.ac.uk/Gout/06%20Validation%20and%20publication/01%20Post%20stakeholder%20draft/2.%20Evidence%20reviews/F_Evidence%20review_ULT%20timing%204.1b%20clean.docx" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">evidence review F</a> on initiation of ULT confirms flares early in initiation and that the frequency of flares reduces as urate levels are lowered. This evidence although indirect is in keeping with the committee’s experience of a risk of flares following the up-titration of ULT. Flares are painful and distressing and treatments to reduce flares is beneficial for the person with gout. The committee drew upon the indirect evidence within review F and therefore did not consider a research recommendation was of high priority. The committee decided not to search for cohort studies, as RCTs are more robust, and therefore preferential for a question about the effectiveness of drug treatments.</p><p>The committee agreed that the available evidence demonstrated colchicine resulted in a reduction in frequency of flares at 3 and 6 months, and decided to recommend colchicine to people with gout who have chosen to take medication to prevent flares during the initiation and titration of ULT.</p><p>The committee’s experience is that patients commonly attribute flares to ULT and stop ULT as a result. Prophylaxis therefore also improves adherence to ULT by preventing ULT-induced flares. Given the importance of ULT for people with gout the committee considered it important that people are supported to persevere with the initiation of this treatment. The committee agreed a strong recommendation for people to be offered and informed about treatments to reduce flares during this important time.</p><p>The committee reported that current practice is to prescribe colchicine or NSAIDs when pharmacological prophylaxis is offered to people with gout. A recommendation to prescribe colchicine is therefore not a change in practice.</p><p>However, colchicine may not be appropriate for some individuals due to tolerability, patient preferences (e.g. past experiences with a particular intervention), co-morbidities (e.g. chronic kidney disease) and co-prescription (e.g. statins). In cases where colchicine is not tolerated, contraindicated or ineffective, use of NSAIDs or corticosteroids should be considered. The committee noted that in their experience NSAIDs are well tolerated in people with gout and can be easily accessed over the counter. Although no evidence had been identified for either NSAIDS or corticosteroids the committee agreed an alternative treatment option needs to be available to manage a person’s pain which can be severe. The committee therefore decided to make a consensus recommendation to consider either an NSAID or corticosteroid if colchicine was not suitable during initiation of ULT. The committee also discussed adding a proton pump inhibitor for people prescribed either of these drugs as they might be used over several weeks or months, taking into account a person’s risk factors for adverse events.</p><p>Because NSAID and corticosteroid drugs are widely prescribed in current practice, the committee agreed it was important to learn more about their clinical effectiveness in this situation to inform and extend choice of prophylactic interventions. The committee therefore agreed randomised controlled trials are required and made a research recommendation on the clinical and cost effectiveness of these drugs for the prevention of flares during initiation or titration of ULT.</p><p>The evidence review included one RCT comparing colchicine and canakinumab which showed clinical benefit for canakinumab for frequency of flares. IL-1 inhibitors are rarely prescribed to people with gout. Use of IL-1 inhibitors requires close monitoring and are currently only prescribed in secondary care for individuals with gout that is more severe. As most people with gout are managed in primary care the use of IL-1 inhibitors would require referral to rheumatology services which would add to cost and resource use. The committee weighed up these considerations alongside the evidence and concluded there is insufficient evidence to recommend IL-1 inhibitors over or instead of other treatments currently used routinely within clinical practice unless all of the other drug options are unsuitable.</p><p>The committee noted that some people may not want prophylactic treatment as they are already taking other pharmacological medications, they consider their condition not severe enough or they have had few flares. The committee discussed that it is important that healthcare professionals have a conversation with patients about the benefits and risks of using pharmacological interventions to prevent gout flares when initiating ULT and made recommendations for this discussion. Some of the discussion points to have with people could include the chance of gout flares without prophylaxis, noting one of the included studies reported that 3 in 4 participants had a flare after ULT initiation and that flares reduce in frequency when the target serum urate level has been reached. Healthcare professionals should explain the risk of gastrointestinal adverse events, so patients are prepared for this.</p><p>The BNF suggests colchicine 500 micrograms twice daily for short-term prophylaxis. In people with CKD, lower doses of Colchicine should be given and NSAIDs avoided. If there are any concerns around drug use and dosages for people with CKD, the committee suggested that GPs speak to the local renal team.</p></div><div id="niceng219er8.s1.1.11.4"><h5>1.1.11.4. Cost effectiveness and resource use</h5><p>No economic evaluations were identified for this review. Unit costs were presented to the committee to aid committee consideration of cost effectiveness.</p><p>The clinical evidence presented indicated a clinical benefit for colchicine; reducing the frequency of flares compared to no treatment and placebo. The committee noted that typically patients will receive prophylaxis for every month they are up titrated on their ULT until they achieve target serum urate levels. For example, someone achieving target serum urate levels on 400mg of allopurinol will receive 4 months of prophylaxis. The cost of one month of prophylaxis assuming 1-2mg of colchicine is prescribed per day is £3.04 - £6.08.</p><p>It was discussed that current practice varies with respect to offering prophylaxis for the prevention of gout flares. The committee noted that the benefits of prophylaxis should be discussed with all patients initiating and up titrating ULT, however the committee acknowledged that some people may choose not to receive prophylaxis because they are already on a large number of medications or because they decide the potential side effects outweighs the benefits of reduced flare frequency. The committee concluded that colchicine should be offered for those people who decide to use prophylaxis when initiating and up titrating ULT due to the low costs and clinical effectiveness associated with offering prophylaxis. This recommendation is not expected to result in a direct substantial resource impact. However, as a result of the recommendations made in this guideline more people are expected to be prescribed ULT and therefore this may also increase the number of people receiving prophylaxis.</p><p>There was no clinical evidence identified for the use of NSAIDs and corticosteroids for preventing gout flares. The committee acknowledged that when colchicine is not tolerated, NSAIDs and corticosteroids (specifically oral prednisolone) are suitable alternatives. The daily cost of NSAIDs ranges from £0.07 – £8.66 per day and the daily cost oral prednisolone is £0.03 – £0.39 per day. The monthly cost for NSAIDS and oral prednisolone for prophylaxis are £2.13 – £263.41 and £0.89 – £11.57 respectively. The committee noted that the large range observed for the cost of NSAIDs was largely driven by the cost of effervescent tablets for naproxen, which small numbers of people with gout would receive. Excluding these costs, the cost ranges from £0.07 - £1.806. Subsequently resulting in a monthly cost of £2.13 – £54.93.</p><p>The committee also discussed the use IL-1 inhibitors for prophylaxis and noted less than 1% of gout patients would be prescribed an IL-1 inhibitor. In general, the committee noted not only the high costs of IL-1 inhibitors, but also the additional costs associated, with respect to monitoring and costs associated with higher risk of infections, due to IL-1 inhibitors being immunosuppressive, compared to NSAIDs, colchicine, and corticosteroids. The committee also discussed the clinical evidence presented and acknowledged that although canakinumab was more effective than colchicine at reducing the frequency of flares (by 276 per 1,000 as defined by people experiencing ≥ 1 flare at 4 months), the benefits of reduced flare frequency could not be offset by the substantial cost differential (£9,928 per injection when initiating or up titrating ULT compared to £3.04 - £6.08 for one month of colchicine). Therefore, the committee concluded that canakinumab for the prevention of gout flares when initiating and titrating ULT would very unlikely be a cost-effective use of NHS resources if routinely prescribed to all people with gout.</p><p>The committee also discussed the use of anakinra, but noted no clinical evidence was found for this. In general, the committee discussed that anakinra would be prescribed in the form self-administered daily injections for the duration of initiation and up titration of ULT. The monthly cost of anakinra is £797.83. In addition, the committee noted that in clinical practice IL-1 inhibitors can only be prescribed in secondary care, and so may not be appropriate to use when patients are initiating or titrating ULT.</p><p>Overall due to the uncertainty surrounding the cost effectiveness of IL-1 inhibitors, the committee made a do not offer recommendation for the use of IL-1 inhibitors when initiating or titrating ULT for the prevention of gout flares unless colchicine, NSAIDs or corticosteroids are contraindicated, not tolerated, or ineffective. The committee also noted that for people where colchicine, NSAIDs or corticosteroids are contraindicated, not tolerated, or ineffective an option of ‘no prophylaxis’ is also appropriate. In addition, the committee noted that although anakinra is significantly cheaper than canakinumab, they concluded they could not make a recommendation for the use of anakinra as a first-line IL-1 inhibitor due to the lack of clinical evidence. However, the committee did discuss the efficacy of these drugs observed in clinical practice and concluded there were no significant differences in the efficacy of anakinra and canakinumab when used as prophylaxis. This recommendation is not expected to result in a substantial resource impact as it is reflective of current practice in England. That is, approximately 1% of gout patients would receive IL-1 inhibitors.</p><p>Of note, the recommendations made as part of this guideline will likely result in an uptake of ULT and therefore more people may be prescribed prophylaxis.</p></div></div><div id="niceng219er8.s1.1.12"><h4>1.1.12. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.5.11 to 1.5.14 and the research recommendation on the clinical and cost effectiveness of NSAIDs or corticosteroids for preventing gout flares during the initiation or titration of urate-lowering therapy.</p></div><div id="niceng219er8.s1.1.rl.r1"><h4>1.1.13. References</h4><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref1">BMJ Group and the Royal Pharmaceutical Society of Great Britain. British National Formulary. Available from: <a href="https://bnf.nice.org.uk/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://bnf<wbr style="display:inline-block"></wbr>​.nice.org.uk/</a> Last accessed: September 2021.</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref2">Borstad
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GC, Bryant
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LR, Abel
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MP, Scroggie
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DA, Harris
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MD, Alloway
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JA. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. Journal of Rheumatology. 2004; 31(12):2429–2432 [<a href="https://pubmed.ncbi.nlm.nih.gov/15570646" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15570646</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref3">Eminaga
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F, La-Crette
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J, Jones
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A, Abhishek
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A. Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review. Rheumatology International. 2016; 36(12):1747–1752 [<a href="/pmc/articles/PMC5102948/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5102948</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27761603" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27761603</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref4">Feng
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X, Li
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Y, Gao
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W. Prophylaxis on gout flares after the initiation of urate-lowering therapy: a retrospective research. International Journal of Clinical and Experimental Medicine. 2015; 8(11):21460–21465 [<a href="/pmc/articles/PMC4723937/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4723937</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26885092" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26885092</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref5">Karimzadeh
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H, Nazari
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J, Mottaghi
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P, Kabiri
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P. Different duration of colchicine for preventing recurrence of gouty arthritis. Journal of Research in Medical Sciences. 2006; 11(2):104–107</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref6">Latourte
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A, Bardin
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T, Richette
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P. Prophylaxis for acute gout flares after initiation of urate-lowering therapy. Rheumatology. 2014; 53(11):1920–1926 [<a href="https://pubmed.ncbi.nlm.nih.gov/24758886" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24758886</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref7">Mitha
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E, Schumacher
|
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HR, Fouche
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L, Luo
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SF, Weinstein
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SP, Yancopoulos
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GD
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et al. Rilonacept for gout flare prevention during initiation of uric acid-lowering therapy: results from the PRESURGE-2 international, phase 3, randomized, placebo-controlled trial. Rheumatology. 2013; 52(7):1285–1292 [<a href="https://pubmed.ncbi.nlm.nih.gov/23485476" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23485476</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref8">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>9.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref9">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>10.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref10">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>11.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref11">Paulus
|
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HE, Schlosstein
|
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LH, Godfrey
|
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RG, Klinenberg
|
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JR, Bluestone
|
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R. Prophylactic colchicine therapy of intercritical gout. A placebo-controlled study of probenecid-treated patients. Arthritis and Rheumatism. 1974; 17(5):609–614 [<a href="https://pubmed.ncbi.nlm.nih.gov/4606955" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4606955</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref12">Robinson
|
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PC, Dalbeth
|
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N, Donovan
|
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P. Colchicine Prophylaxis of Gout Flares When Commencing Allopurinol is Very Cost Effective. Arthritis Care and Research. 2020; 17:17 [<a href="https://pubmed.ncbi.nlm.nih.gov/32558298" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32558298</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref13">Schlesinger
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N, Mysler
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E, Lin
|
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HY, De Meulemeester
|
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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>14.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref14">Schumacher
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HR, Jr., Sundy
|
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JS, Terkeltaub
|
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R, Knapp
|
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HR, Mellis
|
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SJ, Stahl
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N
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et al. Rilonacept (interleukin-1 trap) in the prevention of acute gout flares during initiation of urate-lowering therapy: results of a phase II randomized, double-blind, placebo-controlled trial. Arthritis and Rheumatism. 2012; 64(3):876–884 [<a href="https://pubmed.ncbi.nlm.nih.gov/22223180" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22223180</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref15">Seth
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R, Kydd
|
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AS, Falzon
|
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L, Bombardier
|
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C, van der Heijde
|
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DM, Edwards
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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>16.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref16">Shiozawa
|
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A, Szabo
|
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SM, Bolzani
|
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A, Cheung
|
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A, Choi
|
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HK. Serum uric acid and the risk of incident and recurrent gout: A systematic review. Journal of Rheumatology. 2017; 44(3):388–396 [<a href="https://pubmed.ncbi.nlm.nih.gov/28148699" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28148699</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref17">Singh
|
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JA, Reddy
|
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SG, Kundukulam
|
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J. Risk factors for gout and prevention: a systematic review of the literature. Current Opinion in Rheumatology. 2011; 23(2):192–202 [<a href="/pmc/articles/PMC4104583/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4104583</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21285714" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21285714</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref18">Stewart
|
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S, Tallon
|
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A, Taylor
|
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WJ, Gaffo
|
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A, Dalbeth
|
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N. How flare prevention outcomes are reported in gout studies: A systematic review and content analysis of randomized controlled trials. Seminars in Arthritis and Rheumatism. 2020; 50(2):303–313 [<a href="https://pubmed.ncbi.nlm.nih.gov/31796212" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31796212</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref19">Sundy
|
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JS, Schumacher
|
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HR, Kivitz
|
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A, Weinstein
|
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SP, Wu
|
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R, King-Davis
|
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et al. Rilonacept for gout flare prevention in patients receiving uric acid-lowering therapy: results of RESURGE, a phase III, international safety study. Journal of Rheumatology. 2014; 41(8):1703–1711 [<a href="https://pubmed.ncbi.nlm.nih.gov/25028379" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25028379</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref20">Sutaria
|
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S, Katbamna
|
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R, Underwood
|
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M. Effectiveness of interventions for the treatment of acute and prevention of recurrent gout - A systematic review. Rheumatology. 2006; 45(11):1422–1431 [<a href="https://pubmed.ncbi.nlm.nih.gov/16632483" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16632483</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref21">Vinik
|
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O, Wechalekar
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MD, Falzon
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L, Buchbinder
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R, van der Heijde
|
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DM, Bombardier
|
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C. Treatment of asymptomatic hyperuricemia for the prevention of gouty arthritis, renal disease, and cardiovascular events: a systematic literature review. Journal of Rheumatology - Supplement. 2014; 92:70–74 [<a href="https://pubmed.ncbi.nlm.nih.gov/25180131" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25180131</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref22">Wortmann
|
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RL, Macdonald
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PA, Hunt
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B, Jackson
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RL. Effect of prophylaxis on gout flares after the initiation of urate-lowering therapy: analysis of data from three phase III trials. Clinical Therapeutics. 2010; 32(14):2386–2397 [<a href="https://pubmed.ncbi.nlm.nih.gov/21353107" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21353107</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref23">Yamanaka
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H, Tamaki
|
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S, Ide
|
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Y, Kim
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H, Inoue
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K, Sugimoto
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M
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et al. Stepwise dose increase of febuxostat is comparable with colchicine prophylaxis for the prevention of gout flares during the initial phase of urate-lowering therapy: results from FORTUNE-1, a prospective, multicentre randomised study. Annals of the Rheumatic Diseases. 2018; 77(2):270–276 [<a href="/pmc/articles/PMC5867413/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5867413</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29102957" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29102957</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng219er8.s1.1.ref24">Yu
|
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J, Qiu
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Q, Liang
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L, Yang
|
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X, Xu
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H. Prophylaxis of acute flares when initiating febuxostat for chronic gouty arthritis in a real-world clinical setting. Modern Rheumatology. 2018; 28(2):339–344 [<a href="https://pubmed.ncbi.nlm.nih.gov/28485997" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28485997</span></a>]</div></dd></dl></dl></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng219er8.appa"><h3>Appendix A. Review protocols</h3><p id="niceng219er8.appa.et1"><a href="/books/NBK586319/bin/niceng219er8-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for colchicine, NSAIDs, corticosteroids and IL-1 inhibitors for the prevention of gout flares during the initiation or titration of urate-lowering therapy</a><span class="small"> (PDF, 196K)</span></p><p id="niceng219er8.appa.et2"><a href="/books/NBK586319/bin/niceng219er8-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic review protocol</a><span class="small"> (PDF, 134K)</span></p></div><div id="niceng219er8.appb"><h3>Appendix B. Literature search strategies</h3><ul><li class="half_rhythm"><div>In people with gout (including people with gout and chronic kidney disease), what is the clinical and cost effectiveness of colchicine, NSAIDs, corticosteroids and IL-1 inhibitors for the prevention of gout flares during the initiation or titration of urate-lowering therapy?</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="#niceng219er8.s1.1.ref9" rid="niceng219er8.s1.1.ref9"><sup>9</sup></a></p><p>For more information, please see the <a href="/books/NBK586319/bin/methods-pdf-11132544061.pdf">Methodology</a> review published as part of the accompanying documents for this guideline.</p><p id="niceng219er8.appb.et1"><a href="/books/NBK586319/bin/niceng219er8-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 204K)</span></p><p id="niceng219er8.appb.et2"><a href="/books/NBK586319/bin/niceng219er8-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 163K)</span></p></div><div id="niceng219er8.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng219er8.appc.et1"><a href="/books/NBK586319/bin/niceng219er8-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of colchicine, NSAIDs, corticosteroids and IL-1 inhibitors for the prevention of gout flares during the initiation or titration of urate-lowering therapy</a><span class="small"> (PDF, 131K)</span></p></div><div id="niceng219er8.appd"><h3>Appendix D. Effectiveness evidence</h3><p id="niceng219er8.appd.et1"><a href="/books/NBK586319/bin/niceng219er8-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (202K)</span></p></div><div id="niceng219er8.appe"><h3>Appendix E. Forest plots</h3><p id="niceng219er8.appe.et1"><a href="/books/NBK586319/bin/niceng219er8-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.1. Colchicine (plus febuxostat 40mg) versus no treatment (febuxostat 40mg)</a><span class="small"> (PDF, 115K)</span></p><p id="niceng219er8.appe.et2"><a href="/books/NBK586319/bin/niceng219er8-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.2. Colchicine (colchicine plus allopurinol) versus placebo (placebo plus allopurinol)</a><span class="small"> (PDF, 130K)</span></p><p id="niceng219er8.appe.et3"><a href="/books/NBK586319/bin/niceng219er8-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.3. Canakinumab (Canakinumab plus allopurinol) versus colchicine (colchicine versus allopurinol)</a><span class="small"> (PDF, 124K)</span></p></div><div id="niceng219er8.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng219er8.appf.et1"><a href="/books/NBK586319/bin/niceng219er8-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 15. Clinical evidence profile: Colchicine (colchicine plus febuxostat 40mg) versus no treatment (febuxostat 40mg)</a><span class="small"> (PDF, 177K)</span></p><p id="niceng219er8.appf.et2"><a href="/books/NBK586319/bin/niceng219er8-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 16. Clinical evidence profile: Colchicine (colchicine plus allopurinol) versus placebo (placebo plus allopurinol)</a><span class="small"> (PDF, 177K)</span></p><p id="niceng219er8.appf.et3"><a href="/books/NBK586319/bin/niceng219er8-appf-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 17. Clinical evidence profile: Canakinumab (Canakinumab plus allopurinol) versus colchicine (colchicine plus allopurinol)</a><span class="small"> (PDF, 175K)</span></p></div><div id="niceng219er8.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng219er8.appg.et1"><a href="/books/NBK586319/bin/niceng219er8-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 11. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 137K)</span></p></div><div id="niceng219er8.apph"><h3>Appendix H. Economic evidence tables</h3><p>None.</p></div><div id="niceng219er8.appi"><h3>Appendix I. Health economic model</h3><p>No original health economic modelling was conducted for this review question.</p></div><div id="niceng219er8.appj"><h3>Appendix J. Excluded studies</h3><p id="niceng219er8.appj.et1"><a href="/books/NBK586319/bin/niceng219er8-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical studies</a><span class="small"> (PDF, 123K)</span></p><p id="niceng219er8.appj.et2"><a href="/books/NBK586319/bin/niceng219er8-appj-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health Economic studies</a><span class="small"> (PDF, 111K)</span></p></div><div id="niceng219er8.appk"><h3>Appendix K. Research recommendations – full details</h3><div id="niceng219er8.appk.s1"><h4>J.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 non-steroidal anti-inflammatory drugs or corticosteroids for preventing gout flares when starting or titrating urate-lowering therapy (ULT)?</p></div><div id="niceng219er8.appk.s2"><h4>J.1.2. Why this is important</h4><p>Gout flares are common during the initiation and titration of urate lowering therapy and these are prevented commonly by co-prescribing ULTs with colchicine. NSAIDs and corticosteroids are also used in clinical practice, especially when colchicine is contraindicated or not tolerated. RCT evidence shows the effectiveness of colchicine but no RCTs evaluating the use of NSAIDs and corticosteroids were identified.</p></div><div id="niceng219er8.appk.s3"><h4>J.1.3. Rationale for research recommendation</h4><p id="niceng219er8.appk.et1"><a href="/books/NBK586319/bin/niceng219er8-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (140K)</span></p></div><div id="niceng219er8.appk.s4"><h4>J.1.4. Modified PICO table</h4><p id="niceng219er8.appk.et2"><a href="/books/NBK586319/bin/niceng219er8-appk-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (95K)</span></p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.5.11 to 1.5.14 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: NBK586319</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36395301" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36395301</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng219er8tab1"><div id="niceng219er8.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/NBK586319/table/niceng219er8.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng219er8.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng219er8.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 about to start use of urate-lowering therapies or titration of urate-lowering therapies (initial and subsequent)</p>
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<p>Urate-lowering therapies:
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<ul><li class="half_rhythm"><div>Xanthine oxidase inhibitor - allopurinol and febuxostat</div></li><li class="half_rhythm"><div>Uricosuric – fenofibrate, losartan and vitamin C</div></li><li class="half_rhythm"><div>Uricase - rasburicase</div></li></ul>
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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 (stages 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_niceng219er8.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention(s)</th><td headers="hd_b_niceng219er8.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
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<ul class="circle"><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></div></li><li class="half_rhythm"><div>Colchicine</div></li><li class="half_rhythm"><div>Corticosteroids
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<ul class="circle"><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></div></li><li class="half_rhythm"><div>IL-1 inhibitors
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<ul class="circle"><li class="half_rhythm"><div>Anakinra</div></li><li class="half_rhythm"><div>Canakinumab</div></li></ul></div></li><li class="half_rhythm"><div>Combine all doses (doses much higher than standard doses will be excluded)</div></li><li class="half_rhythm"><div>Within drug class comparisons will not be made, e.g. IL-1 inhibitors will be combined in analyses</div></li></ul></td></tr><tr><th id="hd_b_niceng219er8.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison(s)</th><td headers="hd_b_niceng219er8.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>No prophylaxis/treatment</div></li><li class="half_rhythm"><div>Placebo</div></li></ul></td></tr><tr><th id="hd_b_niceng219er8.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng219er8.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>frequency of flares</div></li><li class="half_rhythm"><div>patient global assessment of treatment success (e.g. Likert scales, visual analogue scales (VAS), numerical ratings scales (NRS))</div></li><li class="half_rhythm"><div>serum urate levels</div></li><li class="half_rhythm"><div>adverse events – cardiovascular, renal and gastrointestinal (e.g. diarrhoea)</div></li><li class="half_rhythm"><div>admission (hospital and A&E/urgent care)</div></li><li class="half_rhythm"><div>discontinuation of ULT</div></li></ul>
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Timepoints: short (up to two weeks), medium (two to six weeks) and long (> six weeks) term</td></tr><tr><th id="hd_b_niceng219er8.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng219er8.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, 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="figobniceng219er8tab2"><div id="niceng219er8.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/NBK586319/table/niceng219er8.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng219er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng219er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention and comparison</th><th id="hd_h_niceng219er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng219er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><th id="hd_h_niceng219er8.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_niceng219er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Borstad 2004<a class="bibr" href="#niceng219er8.s1.1.ref2" rid="niceng219er8.s1.1.ref2"><sup>2</sup></a></p>
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<p>RCT</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention (n=21):</p>
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<p>Allopurinol was initiated at 100 mg orally once a day. The dose of allopurinol was increased in 100 mg increments until a serum urate level of <6.5 mg/dl was attained. Participants received colchicine 0.6 mg orally twice a day. Colchicine was continued for at least 3 months after reaching target serum urate level (average duration = 5.21 months).</p>
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<p>Comparison (n=22):</p>
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<p>Allopurinol was initiated at 100 mg orally once a day. The dose of allopurinol was increased in 100 mg increments until a serum urate level of <6.5 mg/dl was attained. Participants received placebo orally twice a day. Placebo was continued for at least 3 months after reaching target serum urate level (average duration = 5.18 months).</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>n=43</p>
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<p>People with crystal-proven gouty arthritis and frequent attacks of gout at least 3 attacks per year</p>
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<p>Age (mean): intervention - 63.5 years; comparison - 62.5 years Gender (male %): intervention - 81%; comparison - 91% Chronic kidney disease (chronic renal insufficiency, defined as a creatinine clearance of 20–50 ml/min): intervention – 14%; comparison – 9%</p>
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<p>USA</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Frequency of flares (people experiencing one flare) at 6 months</p>
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<p>Frequency of flares (people experiencing >one flare) at 6 months</p>
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<p>Adverse events (gastrointestinal) at 6 months</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity of flares measured using VAS – doesn’t report how “severity” was defined – not extracted</td></tr><tr><td headers="hd_h_niceng219er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Schlesinger 2011 13</p>
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<p>RCT</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention (n=108):</p>
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<p>Allopurinol treatment (100–300 mg) was initiated at baseline or within 1 month before baseline and was administered to all randomised patients once daily for 24 weeks receive a single dose of canakinumab 100 mg and 200 mg.</p>
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<p>Comparison (n=108)</p>
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<p>Allopurinol treatment (100–300mg) was initiated at baseline or within 1 month before baseline and was administered to all randomised patients once daily for 24 weeks. Daily oral doses of colchicine 0.5 mg given for 16 weeks.</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>n=216</p>
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<p>People with gouty arthritis at least two gouty arthritis flares in the previous year</p>
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<p>Age (mean):</p>
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<p>intervention – 52.0 years; comparison – 52.4 years Gender (male %): intervention - 90.8%; comparison – 93.5% Chronic kidney disease (low creatinine clearance): intervention – 7.4%; comparison – 5.6%</p>
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<p>Multicentre, 16 countries: Argentina, Belgium, Columbia, Czech Republic, Germany, Guatemala, Hungary, Poland, Portugal, Russia, Singapore, Slovakia, South Africa, Spain, Taiwan, Turkey, UK and USA</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Frequency of flares (people experiencing ≥1 flares) at 4 months</p>
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<p>Adverse events (gastrointestinal) at 6 months</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Dosing study – 100mg and 200mg arms combined</p>
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<p>Other doses (not relevant): 25mg, 50mg, 300mg or 4-weekly intervals (50mg on day 1 and at week 4, and 25mg at weeks 8 and 12)</p>
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<p>Creatinine clearance determined using Cockcroft-Gault Equation</p>
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</td></tr><tr><td headers="hd_h_niceng219er8.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Yamanaka 2018 23: FORTUNE-1 trial</p>
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<p>RCT</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Intervention (n=102)</p>
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<p>Febuxostat 40 mg/day from the start of the study for total duration of 24 weeks, with concomitant colchicine 0.5 mg/day for 12 weeks.</p>
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<p>Comparison (n=52)</p>
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<p>Febuxostat 40 mg/day from the start of the study for total duration of 24 weeks.</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>n=154 (n=255 for all randomised arms of the trial)</p>
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<p>People with gout who had at least one episode of gouty arthritis in the previous year</p>
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<p>Age (mean): intervention – 47.6 years; comparison – 46.4 years Gender (male %): 100% in all groups</p>
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<p>Chronic kidney disease: 0% (patients with serum creatinine level of 2.0 mg/dL or higher excluded from study)</p>
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<p>Japan</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Frequency of flares (patients who needed analgesic treatment with NSAIDs or adrenal corticosteroids to manage gout symptoms) at 3 months</p>
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<p>Adverse events (cardiovascular) at 6 months</p>
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<p>Adverse events (gastrointestinal) at 6 months</p>
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<p>Adverse events (renal) at 6 months</p>
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</td><td headers="hd_h_niceng219er8.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Percentage of patients whose serum urate decreased to 6.0mg/dL reported in <a href="#niceng219er8.appc.et1">Figure 1</a>. Raw data not reported.</p>
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<p>Other arm of trial: stepwise dose increase of febuxostat from 10mg/day (4 weeks), 20mg/day (4 weeks) and 40mg/day</p>
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|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng219er8tab3"><div id="niceng219er8.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: Colchicine (colchicine plus febuxostat 40mg) versus no treatment (febuxostat 40mg)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586319/table/niceng219er8.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng219er8.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng219er8.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng219er8.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng219er8.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er8.tab3_1_1_1_5" id="hd_h_niceng219er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with no treatment</th><th headers="hd_h_niceng219er8.tab3_1_1_1_5" id="hd_h_niceng219er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Colchicine</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Frequency of flares at 3 months</td><td headers="hd_h_niceng219er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>145</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.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_niceng219er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.53</p>
|
|
<p>(0.30 to 0.92)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">360 per 1,000</td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>169 fewer per 1,000</p>
|
|
<p>(252 fewer to 29 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (cardiovascular) at 6 months</td><td headers="hd_h_niceng219er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>145</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.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_niceng219er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD 0 (0.03 to 0.03)<sup>b</sup></td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1,000</td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>0 fewer per 1,000</p>
|
|
<p>(30 fewer to 30 more)<sup>b</sup></p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (gastrointestinal) at 6 months</td><td headers="hd_h_niceng219er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>145</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup></td><td headers="hd_h_niceng219er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Peto OR 4.60</p>
|
|
<p>(0.07 to 284.25)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1,000</td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>10 more per 1,000</p>
|
|
<p>(30 fewer to 50 more)<sup>c</sup></p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er8.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (renal) at 6 months</td><td headers="hd_h_niceng219er8.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>145</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW<sup>a</sup></td><td headers="hd_h_niceng219er8.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Peto OR 4.60</p>
|
|
<p>(0.07 to 284.25)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1,000</td><td headers="hd_h_niceng219er8.tab3_1_1_1_5 hd_h_niceng219er8.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>10 more per 1,000</p>
|
|
<p>(30 fewer to 50 more)<sup>c</sup></p>
|
|
</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="niceng219er8.tab3_1"><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 dichotomous outcomes MIDs were taken to be RRs of 0.8 and 1.25.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng219er8.tab3_2"><p class="no_margin">Zero events in both arms. Risk difference calculated in Review Manager.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng219er8.tab3_3"><p class="no_margin">Absolute effects calculated using risk difference due to zero events in one of the arms.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er8tab4"><div id="niceng219er8.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Colchicine (colchicine plus allopurinol) versus placebo (placebo plus allopurinol)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586319/table/niceng219er8.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng219er8.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng219er8.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng219er8.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng219er8.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er8.tab4_1_1_1_5" id="hd_h_niceng219er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with no treatment</th><th headers="hd_h_niceng219er8.tab4_1_1_1_5" id="hd_h_niceng219er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Colchicine</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Frequency of flares (people experiencing 1 flare) at 6 months</td><td headers="hd_h_niceng219er8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>43</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.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_niceng219er8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.43</p>
|
|
<p>(0.23 to 0.82)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab4_1_1_1_5 hd_h_niceng219er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">773 per 1,000</td><td headers="hd_h_niceng219er8.tab4_1_1_1_5 hd_h_niceng219er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>440 fewer per 1,000</p>
|
|
<p>(595 fewer to 139 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Frequency of flares (people experiencing >1 flare) at 6 months</td><td headers="hd_h_niceng219er8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>43</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>a</sup></td><td headers="hd_h_niceng219er8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.22</p>
|
|
<p>(0.08 to 0.67)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab4_1_1_1_5 hd_h_niceng219er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">636 per 1,000</td><td headers="hd_h_niceng219er8.tab4_1_1_1_5 hd_h_niceng219er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>496 fewer per 1,000</p>
|
|
<p>(585 fewer to 210 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er8.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (gastrointestinal) at 6 months</td><td headers="hd_h_niceng219er8.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>43</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.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_niceng219er8.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 8.38</p>
|
|
<p>(1.14 to 61.37)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab4_1_1_1_5 hd_h_niceng219er8.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45 per 1,000</td><td headers="hd_h_niceng219er8.tab4_1_1_1_5 hd_h_niceng219er8.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>335 more per 1,000</p>
|
|
<p>(6 more to 1,000 more)</p>
|
|
</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="niceng219er8.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="niceng219er8.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. GRADE default MIDs used; 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="figobniceng219er8tab5"><div id="niceng219er8.tab5" class="table"><h3><span class="label">Tale 5</span><span class="title">Clinical evidence summary: Canakinumab (canakinumab plus allopurinol) versus colchicine (colchicine versus allopurinol)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586319/table/niceng219er8.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng219er8.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng219er8.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng219er8.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng219er8.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng219er8.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng219er8.tab5_1_1_1_5" id="hd_h_niceng219er8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with no treatment</th><th headers="hd_h_niceng219er8.tab5_1_1_1_5" id="hd_h_niceng219er8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Colchicine</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Frequency of flares (people experiencing ≥1 flares) at 4 months</td><td headers="hd_h_niceng219er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>216</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE<sup>a</sup></td><td headers="hd_h_niceng219er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.38</p>
|
|
<p>(0.23 to 0.60)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab5_1_1_1_5 hd_h_niceng219er8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">444 per 1,000</td><td headers="hd_h_niceng219er8.tab5_1_1_1_5 hd_h_niceng219er8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>276 fewer per 1,000</p>
|
|
<p>(342 fewer to 178 fewer)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er8.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events (gastrointestinal) at 6 months</td><td headers="hd_h_niceng219er8.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>216</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng219er8.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_niceng219er8.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 2.67</p>
|
|
<p>(0.73 to 9.78)</p>
|
|
</td><td headers="hd_h_niceng219er8.tab5_1_1_1_5 hd_h_niceng219er8.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 per 1,000</td><td headers="hd_h_niceng219er8.tab5_1_1_1_5 hd_h_niceng219er8.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>46 more per 1,000</p>
|
|
<p>(8 fewer to 244 more)</p>
|
|
</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="niceng219er8.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="niceng219er8.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. GRADE default MIDs used; 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="figobniceng219er8tab6"><div id="niceng219er8.tab6" class="table"><h3><span class="label">Table 6</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/NBK586319/table/niceng219er8.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug</th><th id="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost per unit</th><th id="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Celecoxib 100mg capsules</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">200mg – 400mg</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07 - £0.13</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_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_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.20</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:center;vertical-align:middle;">150mg daily</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.60</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 50mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 60mg tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">120mg daily</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.20</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 400mg tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.2g daily</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.21</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 600mg tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.8g daily</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indomethacin 50mg capsules</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">150mg – 200mg daily</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18 - £0.24</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="4" colspan="1" style="text-align:center;vertical-align:middle;">7.5mg – 15mg daily</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg effervescent tablets sugar free</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89</td><td headers="hd_h_niceng219er8.tab6_1_1_1_3" rowspan="6" colspan="1" style="text-align:center;vertical-align:middle;">750mg – 1500mg daily</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£8.66</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.14</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.41</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg/5ml oral suspension</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£1.35</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.51</td></tr><tr><td headers="hd_h_niceng219er8.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg tablets</td><td headers="hd_h_niceng219er8.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.19</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="#niceng219er8.s1.1.ref1" rid="niceng219er8.s1.1.ref1"><sup>1</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er8tab7"><div id="niceng219er8.tab7" class="table"><h3><span class="label">Table 7</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/NBK586319/table/niceng219er8.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug</th><th id="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost per unit</th><th id="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Celecoxib 100mg capsules</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">100mg – 400mg</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03 - £0.13</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 25mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="5" colspan="1" style="text-align:center;vertical-align:middle;">75 – 150mg daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_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_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.26</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.79</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_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_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.14</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.43</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 75mg modified-release capsules</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.20</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.61</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 75mg modified-release tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.31</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.94</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 60mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">60mg – 120mg daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10 – £0.20</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 90mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.09</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">90mg daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.09</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 200mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.04</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">600mg daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 400mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.2g daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.21</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 600mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.8g daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indomethacin 50mg capsules</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">150mg – 200mg daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18 - £0.24</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="4" colspan="1" style="text-align:center;vertical-align:middle;">7.5mg – 15mg daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 15mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg effervescent tablets sugar free</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89</td><td headers="hd_h_niceng219er8.tab7_1_1_1_3" rowspan="6" colspan="1" style="text-align:center;vertical-align:middle;">500mg – 1000mg daily</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£5.78 – £11.56</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.08</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.16 – £0.32</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10 – £0.20</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg/5ml oral suspension</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.90 – £1.80</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17 - £0.34</td></tr><tr><td headers="hd_h_niceng219er8.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg tablets</td><td headers="hd_h_niceng219er8.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06 - £0.12</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="#niceng219er8.s1.1.ref1" rid="niceng219er8.s1.1.ref1"><sup>1</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er8tab8"><div id="niceng219er8.tab8" class="table"><h3><span class="label">Table 8</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/NBK586319/table/niceng219er8.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug</th><th id="hd_h_niceng219er8.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost per unit</th><th id="hd_h_niceng219er8.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er8.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Celecoxib 100mg capsules</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">100mg – 200mg</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.03 - £0.06</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diclofenac sodium 25mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">75mg daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.18</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 30mg tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.22</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">30mg daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.22</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Etoricoxib 60mg tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">60mg daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10</td></tr><tr><th headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_h_niceng219er8.tab8_1_1_1_2 hd_h_niceng219er8.tab8_1_1_1_3 hd_h_niceng219er8.tab8_1_1_1_4" id="hd_b_niceng219er8.tab8_1_1_5_1" colspan="4" rowspan="1" style="text-align:left;vertical-align:top;">
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<i>
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<u>Ibuprofen</u>
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</i>
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</th></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 200mg tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.04</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">600mg daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ibuprofen 400mg tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.07</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.2g daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.21</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indomethacin 25mg capsules</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">75mg – 100mg daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.15 - £0.20</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg orodispersible tablets sugar free</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="2" colspan="1" style="text-align:center;vertical-align:middle;">7.5mg daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.85</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meloxicam 7.5mg tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.11</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg effervescent tablets sugar free</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89</td><td headers="hd_h_niceng219er8.tab8_1_1_1_3 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="6" colspan="1" style="text-align:center;vertical-align:middle;">250mg – 750mg daily</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£2.89 – £8.67</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.08</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.08 – £0.24</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05 – £0.15</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 250mg/5ml oral suspension</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.45 – £1.35</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg gastro-resistant tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.17</td></tr><tr><td headers="hd_h_niceng219er8.tab8_1_1_1_1 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Naproxen 500mg tablets</td><td headers="hd_h_niceng219er8.tab8_1_1_1_2 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab8_1_1_1_4 hd_b_niceng219er8.tab8_1_1_5_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.06</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="#niceng219er8.s1.1.ref1" rid="niceng219er8.s1.1.ref1"><sup>1</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er8tab9"><div id="niceng219er8.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">UK cost of Colchicine</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586319/table/niceng219er8.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug</th><th id="hd_h_niceng219er8.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost per unit</th><th id="hd_h_niceng219er8.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Daily dose</th><th id="hd_h_niceng219er8.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per day</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er8.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Colchicine 500microgram tablets</td><td headers="hd_h_niceng219er8.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er8.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1mg – 2mg daily</td><td headers="hd_h_niceng219er8.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">£0.10 - £0.20</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">Source: NHS Drug Tariff, Accessed October 2021<a class="bibr" href="#niceng219er8.s1.1.ref10" rid="niceng219er8.s1.1.ref10"><sup>10</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er8tab10"><div id="niceng219er8.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">UK cost of Corticosteroids</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586319/table/niceng219er8.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Drug</th><th id="hd_h_niceng219er8.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost per unit</th><th id="hd_h_niceng219er8.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Dosage</th></tr></thead><tbody><tr><th headers="hd_h_niceng219er8.tab10_1_1_1_1 hd_h_niceng219er8.tab10_1_1_1_2 hd_h_niceng219er8.tab10_1_1_1_3" id="hd_b_niceng219er8.tab10_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3.94</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_1_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£7.06</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_1_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£8.96</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_1_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3.44</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_1_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£6.18</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection on initiation or titration of ULT</td></tr><tr><th headers="hd_h_niceng219er8.tab10_1_1_1_1 hd_h_niceng219er8.tab10_1_1_1_2 hd_h_niceng219er8.tab10_1_1_1_3" id="hd_b_niceng219er8.tab10_1_1_7_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Prednisolone</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prednisolone 2.5mg tablets</td><td headers="hd_h_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.13</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5mg – 7.5mg daily</td></tr><tr><td headers="hd_h_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prednisolone 5mg tablets</td><td headers="hd_h_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.03</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5mg – 7.5mg daily</td></tr><tr><th headers="hd_h_niceng219er8.tab10_1_1_1_1 hd_h_niceng219er8.tab10_1_1_1_2 hd_h_niceng219er8.tab10_1_1_1_3" id="hd_b_niceng219er8.tab10_1_1_10_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Triamcinolone</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Triamcinolone acetonide 10mg/1ml suspension for injection ampoules</td><td headers="hd_h_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.89</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_10_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_1_1_10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.49</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_10_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_1_1_10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3.63</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_10_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_niceng219er8.tab10_1_1_1_1 hd_b_niceng219er8.tab10_1_1_10_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_niceng219er8.tab10_1_1_1_2 hd_b_niceng219er8.tab10_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£12.00</td><td headers="hd_h_niceng219er8.tab10_1_1_1_3 hd_b_niceng219er8.tab10_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection on initiation or titration of ULT</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="#niceng219er8.s1.1.ref10" rid="niceng219er8.s1.1.ref10"><sup>10</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er8tab11"><div id="niceng219er8.tab11" class="table"><h3><span class="label">Table 11</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/NBK586319/table/niceng219er8.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug</th><th id="hd_h_niceng219er8.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_h_niceng219er8.tab11_1_1_1_2 hd_h_niceng219er8.tab11_1_1_1_3" id="hd_b_niceng219er8.tab11_1_1_1_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:bottom;">Omeprazole</th></tr><tr><td headers="hd_h_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Omeprazole 10mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.33</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Omeprazole 20mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.49</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Omeprazole 40mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.98</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_h_niceng219er8.tab11_1_1_1_2 hd_h_niceng219er8.tab11_1_1_1_3" id="hd_b_niceng219er8.tab11_1_1_5_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:bottom;">Esomeprazole</th></tr><tr><td headers="hd_h_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Esomeprazole 20mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.15</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Esomeprazole 40mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.15</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_h_niceng219er8.tab11_1_1_1_2 hd_h_niceng219er8.tab11_1_1_1_3" id="hd_b_niceng219er8.tab11_1_1_8_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:bottom;">Lansoprazole</th></tr><tr><td headers="hd_h_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lansoprazole 15mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.13</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lansoprazole 30mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.18</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_h_niceng219er8.tab11_1_1_1_2 hd_h_niceng219er8.tab11_1_1_1_3" id="hd_b_niceng219er8.tab11_1_1_11_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:bottom;">Rabeprazole</th></tr><tr><td headers="hd_h_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rabeprazole 10mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.05</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rabeprazole 20mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_h_niceng219er8.tab11_1_1_1_2 hd_h_niceng219er8.tab11_1_1_1_3" id="hd_b_niceng219er8.tab11_1_1_14_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">Pantoprazole</th></tr><tr><td headers="hd_h_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pantoprazole 20mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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_niceng219er8.tab11_1_1_1_1 hd_b_niceng219er8.tab11_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pantoprazole 40mg tablets</td><td headers="hd_h_niceng219er8.tab11_1_1_1_2 hd_b_niceng219er8.tab11_1_1_14_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.06</td><td headers="hd_h_niceng219er8.tab11_1_1_1_3 hd_b_niceng219er8.tab11_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="#niceng219er8.s1.1.ref1" rid="niceng219er8.s1.1.ref1"><sup>1</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="figobniceng219er8tab12"><div id="niceng219er8.tab12" class="table"><h3><span class="label">Table 12</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/NBK586319/table/niceng219er8.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er8.tab12_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er8.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug</th><th id="hd_h_niceng219er8.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost per unit</th><th id="hd_h_niceng219er8.tab12_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_niceng219er8.tab12_1_1_1_1 hd_h_niceng219er8.tab12_1_1_1_2 hd_h_niceng219er8.tab12_1_1_1_3" id="hd_b_niceng219er8.tab12_1_1_1_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Anakinra</u>
|
|
</i>
|
|
</th></tr><tr><td headers="hd_h_niceng219er8.tab12_1_1_1_1 hd_b_niceng219er8.tab12_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_niceng219er8.tab12_1_1_1_2 hd_b_niceng219er8.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£26.23</td><td headers="hd_h_niceng219er8.tab12_1_1_1_3 hd_b_niceng219er8.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Daily injections on initiation or titration of ULT<sup>(a)</sup></td></tr><tr><th headers="hd_h_niceng219er8.tab12_1_1_1_1 hd_h_niceng219er8.tab12_1_1_1_2 hd_h_niceng219er8.tab12_1_1_1_3" id="hd_b_niceng219er8.tab12_1_1_3_1" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<i>
|
|
<u>Canakinumab</u>
|
|
</i>
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</th></tr><tr><td headers="hd_h_niceng219er8.tab12_1_1_1_1 hd_b_niceng219er8.tab12_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_niceng219er8.tab12_1_1_1_2 hd_b_niceng219er8.tab12_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£9,928</td><td headers="hd_h_niceng219er8.tab12_1_1_1_3 hd_b_niceng219er8.tab12_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 injection on initiation or titration of ULT</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="#niceng219er8.s1.1.ref1" rid="niceng219er8.s1.1.ref1"><sup>1</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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