ArticleArthritis & rheumatology (Hoboken, N.J.)2025
Comparative Cardiovascular Safety of Nonsteroidal Anti-Inflammatory Drug Versus Colchicine Use When Initiating Urate-Lowering Therapy Among Patients With Gout: Target Trial Emulations.
Article in Arthritis & rheumatology (Hoboken, N.J.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The trial behind it
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Who cites it
4 citing papers in PubMed.
- Treat-to-Target Urate-lowering Therapy: Lessons Learned from the STOP Gout Study.Current rheumatology reports · 2026Review
- Balancing Pain Relief and Safety: Gastrointestinal and Cardiovascular Risk Assessment in Nonsteroidal Anti-Inflammatory Drug Users and the Role of Gastroprotective Co-Therapy.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Controversies in Urate-Lowering Therapy for Gout: A Comprehensive Review.Gout, urate, and crystal deposition disease · 2025Article
- Dysregulated bile acid metabolism as a novel player in gout progression: emerging therapeutic strategies.Frontiers in endocrinology · 2025Review
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
objectiveAmong patients with gout, nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used despite scarce safety data in this specific population. Therefore, we quantified the comparative cardiovascular safety of NSAIDs versus colchicine among patients with gout starting allopurinol.
methodsWe conducted a sequential, propensity score-matched, new-user comparative effectiveness study using the target trial emulation framework to compare the risk of major adverse cardiovascular events (MACE; composite of myocardial infarction [MI], stroke, or cardiovascular death) among patients with gout started on allopurinol who were prescribed NSAIDs or colchicine for gout flare prophylaxis. A sensitivity analysis employed inverse probability of treatment weighting (IPTW). Secondarily, we examined the risk of MACE with colchicine or NSAIDs versus no prophylaxis.
resultsAmong 18,120 propensity score-matched adults with gout starting allopurinol with NSAIDs or colchicine (83.5% male, mean age 60.9 years), the incidence of MACE and cardiovascular death were higher among NSAID users compared to colchicine users, with rate differences of 38.8 (95% confidence interval [CI] 15.4-62.2) and 10.9 (95% CI 0.7-21.1) per 1,000 person-years, respectively, and hazard ratios (HRs) of 1.56 (95% CI 1.11-2.17) and 2.50 (95% CI 1.14-5.26), respectively. Results were similar when IPTW was applied. Compared to no prophylaxis, NSAID use was associated with a higher risk of MACE and MI, with HRs of 1.50 (95% CI 1.17-1.91) and 1.93 (95% CI 1.35-2.75), respectively.
conclusionIn these target trial emulations of patients with gout starting allopurinol, NSAID prophylaxis was associated with a higher risk of MACE than colchicine or no prophylaxis, suggesting the avoidance of NSAID for gout flare prophylaxis.
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