RT Journal Article SR Electronic T1 Preventing Attacks of Acute Gout When Introducing Urate-Lowering Therapy: A Systematic Literature Review JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP 42 OP 47 DO 10.3899/jrheum.140461 VO 92 A1 Rakhi Seth A1 Alison S.R. Kydd A1 Louise Falzon A1 Claire Bombardier A1 Désirée M. van der Heijde A1 Christopher J. Edwards YR 2014 UL http://www.jrheum.org/content/92/42.abstract AB Objective. To systematically review the evidence on treatment available to prevent an acute attack of gout when initiating a urate-lowering therapy (ULT) and for how long this treatment should be continued. To also evaluate the evidence on the optimal time to start a ULT after an acute attack of gout. Methods. A systematic review as part of the 3e (Evidence, Expertise, Exchange) Initiative on Diagnosis and Management of Gout was performed using Medline, Embase, Cochrane Central Register of Controlled Trials (from 1950 to October 2011), and the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) 2010/2011 meeting abstracts. Two reviewers independently screened titles and abstracts for selection criteria. Included articles were reviewed in detail, and a risk of bias assessment (using the Cochrane tool) was performed. Results. The search identified 8168 articles and 197 abstracts, from which 4 randomized controlled trials were included in the review. Two of these studies compared placebo with colchicine, 1 compared differing durations of colchicine, and 1 compared colchicine with canakinumab. Conclusion. Two randomized controlled trials have shown that colchicine prophylaxis for at least 6 months, when starting a ULT, reduces the risk of acute attacks. Canakinumab, although not currently licensed for gout, has been shown to provide prophylaxis superior to colchicine, when starting a ULT. There is no evidence on the optimum time to start a ULT after an acute gout attack.