College of Basic Medical Science, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China.
Inflammopharmacology. 2018 Jun;26(3):717-723. doi: 10.1007/s10787-018-0442-8. Epub 2018 Jan 22.
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.
评估与非甾体抗炎药（NSAIDs）相比，口服泼尼松龙治疗急性痛风的疗效和安全性。
对中、英文数据库进行全面检索。由两位作者独立提取和分析入选研究的数据。
最终分析纳入了 3 项双盲、随机、对照试验，共 584 例患者。在疼痛缓解量表上，口服泼尼松龙（30-35mg/天）与 NSAIDs（萘普生 500mg/天或吲哚美辛 50-100mg/天）在活动时（均数差值 0.259，95%CI-1.532 至 2.050，P=0.777）和休息时（均数差值-0.502，95%CI-4.961 至 3.956，P=0.825）的疗效相当，均在最初的 2-6 小时内。在接下来的 4-6 天内，泼尼松龙在活动时（均数差值-0.552，95%CI-1.364 至 0.260，P=0.183）或休息时（均数差值-0.164，95%CI-0.463 至 0.134，P=0.281）的疗效相当。关于安全性，泼尼松龙并没有增加总的不良反应（AE）发生率（风险比[RR]0.765，95%CI0.473 至 1.238，P=0.275），而且降低了因 AE 而退出的比例（RR0.127，95%CI0.021-0.763，P=0.024）。泼尼松龙降低了一些不良反应的风险（包括消化不良：RR0.544，95%CI0.311-0.952，P=0.033；恶心：RR0.296，95%CI0.136-0.647，P=0.002；呕吐：RR0.155，95%CI0.033-0.722，P=0.018），但增加了皮疹的风险（RR4.049，95%CI1.241-13.158，P=0.021）。
与 NSAIDs 相比，口服泼尼松龙治疗活动期急性痛风的疗效可能相当，且安全性略高。仍需进一步的临床研究来评估其长期疗效和安全性。
