Condition

Gout

Inflammatory arthritis causing sudden severe joint pain

55.8M
People Affected
322
Active Trials
1.7M
New Cases/Year
2,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Pegloticase
90% Effectiveness• 80% Confidence• 45% Safety• 18 trials• 2K participants
MODERATE EvidencePoor ValueDose: 8 mg IV every two weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
45
DangerousModerateSafe

Time to Effect

24 hours (sUA reduction), weeks-months (clinical benefits)

Duration

6-12 months

Response Rate

45%

Remission Rate

35%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

4

Common Side Effects:

Infusion reactions: 40%
Gout flares (initiation): 25%
Nausea: 15%
Antibody formation (loss of efficacy): 30%

Annual Cost of Care

Drug Cost

$234,000

Monitoring

$15,000

Side Effects

$7,000

Total Annual

$256,000

Cost-Effectiveness

POOR

QALYs Gained

1

ICER

$350,000/QALY

Cost per Remission

$731,429

Cost per Responder

$568,889

Treatment Outcomes
Primary Outcomes
Serum Uric Acid (sUA)9.5 mg/dL
-95% (-9.0 mg/dL)
Tophus Burden (Total Area)30 cm²
-80% (-24 cm²)
Pain (VAS Score)VAS Pain Score: 7/10
-57% (-4 points)
Secondary Benefits
Gout Flare Frequency4 flares/year
-75% (-3 flares/year)
Functional Disability (HAQ-DI)HAQ-DI score: 1.5/3
-47% (-0.7 points)
Estimated Glomerular Filtration Rate (eGFR)eGFR: 55 mL/min/1.73m²
+5% (+3 mL/min/1.73m²)
Common Side Effects
Infusion reactions
+40%
Gout flares (initiation)
+25%
Nausea
+15%

Clinical Trial Phases:

Phase 4
2
NSAIDs (e.g., Indomethacin, Naproxen)
88% Effectiveness• 95% Confidence• 75% Safety• 150 trials• 15K participants
HIGH EvidenceExcellent ValueDose: Indomethacin 25-50 mg TID; Naproxen 750 mg initial, then 250 mg Q8hr
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

1-2 hours

Duration

5-10 days (per flare)

Response Rate

90%

Remission Rate

%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

10

Common Side Effects:

GI upset (nausea, dyspepsia): 15%
Fluid retention, edema: 7%
Increased blood pressure: 3%
GI bleeding/ulcer (serious): 0.5%

Annual Cost of Care

Drug Cost

$30

Monitoring

$150

Side Effects

$10

Total Annual

$190

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.007

ICER

$5,000/QALY

Cost per Responder

$211

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+88%
Response Rate
+90%
Common Side Effects
GI upset (nausea, dyspepsia)
+15%
Fluid retention, edema
+7%
Increased blood pressure
+3%

Clinical Trial Phases:

Phase 4
3
Febuxostat
87% Effectiveness• 85% Confidence• 65% Safety• 65 trials• 10K participants
HIGH EvidenceModerate ValueDose: 40 mg or 80 mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

Days-weeks (sUA reduction), 6-12 months (flare reduction)

Duration

lifetime

Response Rate

87%

Remission Rate

70%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

50

Common Side Effects:

Nausea: 3%
Liver function abnormalities: 3%
Gout flares (initiation): 8%
Cardiovascular events: 1%

Annual Cost of Care

Drug Cost

$300

Monitoring

$300

Side Effects

$70

Total Annual

$670

Cost-Effectiveness

MODERATE

QALYs Gained

2.5

ICER

$110,000/QALY

Cost per Remission

$957

Cost per Responder

$770

Treatment Outcomes
Primary Outcomes
Serum Urate Level9.5 mg/dL
-42.1% (-4.0 mg/dL)
Annual Gout Flare Rate4.2 flares/year
-70% (-2.9 flares/year)
Total Tophus Volume150 mm³
-60% (-90.0 mm³)
Secondary Benefits
Gout-Related Pain (NRS Score)6.5/10
-45% (-2.9 points)
HAQ-DI (Disability Score)1.8
-27.8% (-0.5 points)
Acute Gout Attacks Requiring Treatment3.0 episodes/year
-70% (-2.1 episodes/year)
Common Side Effects
Nausea
+3%
Liver function abnormalities
+3%
Gout flares (initiation)
+8%

Clinical Trial Phases:

Phase 4
4
Prednisone (systemic corticosteroids)
86% Effectiveness• 90% Confidence• 50% Safety• 50 trials• 5K participants
HIGH EvidenceExcellent ValueDose: 20-40 mg daily, tapered
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
50
DangerousModerateSafe

Time to Effect

4-24 hours

Duration

5-10 days (tapered)

Response Rate

90%

Remission Rate

%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

7

Common Side Effects:

Hyperglycemia: 15%
Fluid retention, edema: 7%
Insomnia, mood changes: 7%
Increased appetite: 7%

Annual Cost of Care

Drug Cost

$30

Monitoring

$150

Side Effects

$10

Total Annual

$190

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.007

ICER

$6,000/QALY

Cost per Responder

$211

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+86%
Response Rate
+90%
Common Side Effects
Hyperglycemia
+15%
Fluid retention, edema
+7%
Insomnia, mood changes
+7%

Clinical Trial Phases:

Phase 4
5
Allopurinol
85% Effectiveness• 90% Confidence• 65% Safety• 71 trials• 10K participants
HIGH EvidenceExcellent ValueDose: 100-800 mg daily, titrated
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

Days-weeks (sUA reduction), 6-12 months (flare reduction)

Duration

lifetime

Response Rate

85%

Remission Rate

65%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

50

Common Side Effects:

Skin rash: 3%
Diarrhea/Nausea: 2%
Gout flares (initiation): 10%

Annual Cost of Care

Drug Cost

$30

Monitoring

$300

Side Effects

$50

Total Annual

$380

Cost-Effectiveness

EXCELLENT

QALYs Gained

2.5

ICER

$15,000/QALY

Cost per Remission

$585

Cost per Responder

$447

Treatment Outcomes
Primary Outcomes
Serum Urate (sUA)9.5 mg/dL
-42.1% (-4.0 mg/dL)
Annual Gout Flare Rate4.0 flares/year
-75% (-3.0 flares/year)
Total Tophus Volume1.2 cm³
-60% (-0.72 cm³)
Secondary Benefits
Gout-Related Pain (VAS 0-10)6.0 (on a 0-10 scale)
-33.3% (-2.0 points)
Physical Function (HAQ-DI)1.5 (on HAQ-DI 0-3 scale)
-26.7% (-0.4 points)
SF-36 Physical Component Summary Score35 (on a 0-100 scale)
+14.3% (+5 points)
Common Side Effects
Skin rash
+3%
Diarrhea/Nausea
+2%
Gout flares (initiation)
+10%

Clinical Trial Phases:

Phase 4
6
Colchicine
83% Effectiveness• 90% Confidence• 60% Safety• 44 trials• 5K participants
HIGH EvidenceExcellent ValueDose: Acute: 1.2 mg then 0.6 mg 1 hour later; Prophylaxis: 0.6 mg once or twice daily
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

12-24 hours (acute), immediate (prophylaxis effect)

Duration

1-3 days (acute), 3-6 months (prophylaxis)

Response Rate

85%

Remission Rate

%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

7

Common Side Effects:

Diarrhea: 15%
Nausea, vomiting, abdominal pain: 7%

Annual Cost of Care

Drug Cost

$150

Monitoring

$50

Side Effects

$20

Total Annual

$220

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.01

ICER

$8,000/QALY

Cost per Responder

$259

Treatment Outcomes
Primary Outcomes
Pain Intensity (NRS 0-10)7.5 (on a 0-10 scale)
-40% (-3.0 points)
Joint Swelling (0-3 scale)2.5 (on a 0-3 scale)
-40% (-1.0 point)
C-reactive protein (CRP)25 mg/L
-50% (-12.5 mg/L)
Secondary Benefits
Frequency of Gout Attacks (per year)4 attacks/year
-60% (-2.4 attacks/year)
Duration of Acute Gout Attack7.0 days
-30% (-2.1 days)
HAQ-DI score (0-3)1.5 (on a 0-3 scale)
-20% (-0.3 points)
Common Side Effects
Diarrhea
+15%
Nausea, vomiting, abdominal pain
+7%

Clinical Trial Phases:

Phase 4