Oral prednisolone versus non-steroidal anti-inflammatory drugs in the treatment of acute gout: a meta-analysis of randomized controlled trials

To evaluate the efficacy and safety of oral prednisolone in the treatment of acute gout compared with non-steroidal anti-inflammatory drugs (NSAIDs). A comprehensive search of databases in both Chinese and English was performed. Data from the selected studies were extracted and analyzed independently by two authors. Three double-blind, randomized, controlled trials were included in the final analysis, with a total of 584 patients. Regarding the efficacy, oral prednisolone (30-35 mg/day) was comparable with NSAIDs (naproxen at 500 mg/day or indomethacin at 50-100 mg/day) on the pain relief scale, both in activity (difference in means 0.259, 95% CI - 1.532 to 2.050, P = 0.777) and at rest (difference in means - 0.502, 95% CI - 4.961 to 3.956, P = 0.825) during the first 2-6 h. During the following 4 to 6 days, prednisolone acted with comparable efficacy either in activity (difference in means - 0.552, 95% CI - 1.364 to 0.260, P = 0.183) or at rest (difference in means - 0.164, 95% CI - 0.463 to 0.134, P = 0.281). Regarding safety, prednisolone did not increase the total adverse events (AEs) (risk ratios [RR] 0.765, 95% CI 0.473 to 1.238, P = 0.275) and reduced the withdrawal rate because of the AEs (RR 0.127, 95% CI 0.021-0.763, P = 0.024). Prednisolone decreased the risks of several AEs (including indigestion: RR 0.544, 95% CI 0.311-0.952, P = 0.033; nausea: RR 0.296, 95% CI 0.136-0.647, P = 0.002; and vomiting: RR 0.155, 95% CI 0.033-0.722, P = 0.018) but increased the risk of skin rashes (RR 4.049, 95% CI 1.241-13.158, P = 0.021). Oral prednisolone may be of similar efficacy and a slightly safer strategy for treatment of active, acute gout compared with NSAIDs. Further clinical studies are still warranted to investigate its long-term efficacy and safety.