The safety of treatment options available for gout

ABSTRACT

Introduction: Gout is the most common inflammatory arthritis in humans. Gout treatment includes rapid initiation of anti-inflammatory medications for acute attacks and chronically treating with urate lowering drugs as well as chronic anti-inflammatory prophylaxis.

Areas covered: This review aims to provide an overview and discussion of the safety concerns of current treatment options available for gout.

Expert opinion: Gout is a curable disease with appropriate treatment. The advent of new therapies provides encouraging opportunities to improve gout management. However, clinicians should be aware of some of the safety concerns of medications used to treat acute and chronic gout. When prescribing medications for gout one has to be mindful of the presence of comorbidities commonly affecting gout patients that may affect drug safety and efficacy, especially in the elderly and in patients treated with multiple drugs.

The benefits of gout drugs, usually, outweigh their safety concerns. Studies are needed in gout patients with chronic kidney disease and/or cardiovascular disease, so that escalation of dosing /combination of anti-inflammatory drugs needed to suppress gouty inflammation as well as escalation of dosing/combination of urate lowering drugs needed to achieve target serum urate level will lead to better understanding of gout treatment safety issues.

KEYWORDS:

• Safety
• acute gout
• anti-inflammatory drugs
• chronic gout
• urate lowering drugs
• uric acid

Article highlights

• The benefits of gout drugs, usually, outweigh their safety concerns.

• One has to be mindful of underlying comorbidities in gout patients when prescribing drugs for gout.

• Evaluation of toxicities in elderly gout patients and drug interactions that increase the potential for adverse events need to be addressed.

• Combination treatments are commonly used in gout but need further study, especially in patients with underlying comorbidities, to determine which drug combinations are safest.

Including genetic and biomarkers may assist us in better understanding and possibly predicting the safety of current treatment options for gout

This box summarizes key points contained in the article.

Declaration of interest

N Schlesinger has received grants from AstraZeneca, has acted on Advisory boards for Pfizer, Astra Zeneca, ProteoThera and Celgene, received Speaker’s bureau from Novartis and Takeda and acted as consultant for Novartis, Sobi, BristolMeyersSquibb and Alkermes. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded