The ACR guidelines stress that it is vital to always try to prevent gout attacks during initiation of urate-lowering therapy. The recommended first-line agents for prophylaxis are low-dose colchicine or a low-dose NSAID, with prednisone at a dose not to exceed 10 mg/day reserved as second-line therapy in the event the first-line agents are not tolerated or are ineffective.
Prophylaxis is supposed to continue as long as a patient has any evidence of disease activity. And once all symptoms and tophi have resolved, all measures needed to keep the serum urate below 6.0 mg/dL are to be continued indefinitely.
"For most patients," Dr. Pillinger concluded, "gout treatment is almost always forever."
He reported having received research grants from Takeda, which markets febuxostat in the United States, and Savient, which markets pegloticase.