Summary of findings 3. High‐dose versus low‐dose colchicine for acute gout.
| High‐dose versus low‐dose colchicine for acute gout | ||||||
| Patient or population: people with acute gout Settings: outpatient Intervention: high‐dose versus low‐dose colchicine | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control (low‐dose colchicine) | High‐dose colchicine | |||||
| Pain ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | Not reported |
| Participant global assessment of treatment success: proportion with 50% or greater decrease in pain score from baseline ‐ 32 to 36 hours | 419 per 1000 | 365 per 1000 (235 to 570) | RR 0.87 (0.56 to 1.36) | 126 (1 study) | ⊕⊕⊝⊝ Lowa,b | The evidence suggests little to no difference for the proportion of people reporting treatment success between high‐dose colchicine and low‐dose colchicine. Absolute difference: 5% fewer reported success (23% fewer to 12% more). Relative percentage change: 13% fewer (44% fewer to 136% more) |
| Reduction of inflammation ‐ not measured | See comment | See comment | Not estimable | ‐ | See comment | Not measured |
| Function of target joint ‐ not measured | See comment | See comment | Not estimable | ‐ | See comment | Not measured |
| Serious adverse events | ‐ | ‐ | Not estimable | 126 (1 study) | See comment | One study reported that there were no serious adverse events in either study arm. |
| Total adverse events | 365 per 1000 | 770 per 1000 (551 to 1000) | RR 2.11 (1.51 to 2.95) | 126 (1 study) | ⊕⊕⊝⊝ Lowa,b | High‐dose colchicine may increase the number of adverse events compared to low‐dose colchicine. Absolute difference: 41% more events with high‐dose (19% more to 71% more), compared to low‐dose colchicine. Relative percentage change: 111% more events (51% more to 195% more). NNTH: 3 (2 to 5)c |
| Withdrawals due to adverse events | ‐ | ‐ | Not estimable | 126 (1 study) | See comment | One study reported that there were no withdrawals due to adverse events in either study arm. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; NNTH: number needed to treat for an additional harmful outcome; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
aDowngraded one level due to a risk of selection bias from unclear reporting of the method of randomisation, and a risk of reporting bias. bDowngraded one level for imprecision as the number of events was small (< 200) and 95% CI includes no effect, or appreciable benefit. cNote: number needed to treat for an additional beneficial (NNTB) or harmful outcome (NNTH) is reported when the difference between treatment and control is statistically significant, calculated using Cates NNT calculator for dichotomous outcomes (www.nntonline.net/visualrx).