From the Guidelines
Colchicine is an effective first-line treatment for acute gout attacks when started early, with a recommended regimen of 1.2 mg initially, followed by 0.6 mg one hour later, then 0.6 mg once or twice daily until symptoms resolve. This lower-dose approach has replaced older high-dose regimens due to better tolerability while maintaining effectiveness, as shown in a study published in the Annals of Internal Medicine 1. The study found that lower doses of colchicine are as effective as higher doses at reducing pain and are associated with fewer gastrointestinal adverse effects.
Key Considerations for Colchicine Treatment
- Treatment should begin within 24-36 hours of symptom onset for best results
- Common side effects include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain, which typically indicate the need to reduce or stop the medication
- Colchicine should be used cautiously in patients with kidney or liver impairment, and dose adjustments are necessary for these populations
- The medication works by inhibiting neutrophil migration and activity, thereby reducing the inflammatory response to urate crystals in the joint
- It should not be used in combination with strong CYP3A4 inhibitors or P-glycoprotein inhibitors, as this can increase colchicine levels and toxicity risk, as noted in a guideline from the American College of Physicians 1
Alternative Treatment Options
- For patients unable to tolerate colchicine, NSAIDs or corticosteroids are alternative options for acute gout management, as discussed in a systematic review published in the Annals of Internal Medicine 1
- The choice of alternative treatment should be based on individual patient factors, such as comorbidities and medication interactions
- A study published in the Annals of Internal Medicine found that NSAIDs, such as naproxen and ibuprofen, are effective in reducing pain in patients with acute gout, but may have gastrointestinal adverse effects 1
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Gout Flares Colchicine Tablets, USP are indicated for prophylaxis and the treatment of acute gout flares. Prophylaxis of Gout Flares: Colchicine Tablets, USP are indicated for prophylaxis of gout flares. Treatment of Gout Flares: Colchicine Tablets, USP are indicated for treatment of acute gout flares when taken at the first sign of a flare.
Colchicine treatment for acute gout is indicated when taken at the first sign of a flare 2.
- Key points:
- Colchicine is used for the treatment of acute gout flares.
- It should be taken at the first sign of a flare.
From the Research
Colchicine Treatment for Acute Gout
- Colchicine is approved in the US for the treatment of acute gout flares in adult patients and the prophylaxis of gout flares in patients aged >16 years 3.
- The recommended dosage of Colcrys (1.2 mg at the first sign of the flare, followed by 0.6 mg in 1 hour) was significantly more effective than placebo in treating acute gout flare, as assessed by the proportion of patients experiencing a >or=50% reduction in pain within 24 hours of initiating treatment 3.
Efficacy of Colchicine
- Colchicine is an effective treatment for the reduction of pain and clinical symptoms in patients experiencing acute attacks of gout, although its low benefit to toxicity ratio limits its usefulness 4.
- Low-dose colchicine (1.8 mg over 1 h) taken as early as possible is effective in reducing pain and is well tolerated in patients with acute gout 5.
- Low-quality evidence suggests that low-dose colchicine may improve treatment outcome compared to placebo with little or no increased risk of adverse events 6.
Comparison with Other Treatments
- There is low-quality evidence that low-dose colchicine may be an effective treatment for acute gout when compared to placebo and low-quality evidence that its benefits may be similar to NSAIDs 6.
- No trials reported the effect of colchicine in populations with comorbidities or in comparison with other commonly used treatments, such as glucocorticoids 6.
Adverse Events
- The incidence of gastrointestinal adverse events, such as diarrhea and vomiting, is higher with high-dose colchicine compared to low-dose colchicine or placebo 4, 7, 6.
- Low-quality evidence suggests that high-dose colchicine may increase the number of adverse events compared to placebo, while low-quality evidence indicates that the number of adverse events may be similar with low-dose colchicine and NSAIDs 6.