Is colchicine (Colcrys) indicated for gout in patients with impaired renal function, specifically those with an estimated Glomerular Filtration Rate (eGFR) of 29?

From the Guidelines

Colchicine should be avoided in patients with severe renal impairment, such as an eGFR of 29, due to the increased risk of serious side effects. The safe use of colchicine in patients with severe renal impairment (GFR <30 mL/min) has not been established, as stated in the 2016 updated EULAR evidence-based recommendations for the management of gout 1. This is because colchicine clearance is decreased in patients with severe renal impairment, leading to a potential source of therapeutic misuse if the dosage is reduced.

Key considerations for managing gout in patients with renal impairment include:

• Avoiding colchicine due to its decreased clearance and increased risk of toxicity
• Considering alternative treatments such as NSAIDs, oral corticosteroids, or other options that are safer in the context of renal impairment
• Being aware of the potential interactions between gout medications and other drugs that may affect renal function or increase the risk of side effects, such as P-glycoprotein or CYP3A4 inhibitors 1.

In the context of real-life clinical medicine, prioritizing the patient's safety and minimizing the risk of adverse effects is crucial. Therefore, alternative gout treatments should be considered for patients with an eGFR of 29, taking into account the individual patient's overall health status, comorbidities, and potential drug interactions.

From the FDA Drug Label

For treatment of gout flares in patients with mild (Cl cr 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine However, in patients with severe impairment, while the dose does not need to be adjusted for the treatment of gout flares, a treatment course should be repeated no more than once every two weeks. For patients with gout flares requiring repeated courses, consideration should be given to alternate therapy For patients undergoing dialysis, the total recommended dose for the treatment of gout flares should be reduced to a single dose of 0.6 mg (one tablet). For these patients, the treatment course should not be repeated more than once every two weeks

Colchicine is indicated for gout but with caution and close monitoring in patients with severe renal impairment (eGFR < 30 mL/min), as the treatment course should be repeated no more than once every two weeks.

• The dose does not need to be adjusted for the treatment of gout flares in patients with an eGFR of 29 mL/min, but consideration should be given to alternate therapy for patients requiring repeated courses. 2

From the Research

Colchicine Indication for Gout with eGFR 29

• Colchicine is a treatment option for acute gout, but its use may be limited in patients with severe renal impairment 3.
• The dosing of colchicine may need to be restricted in patients with severe renal and hepatic dysfunction 3.
• There is no specific information in the provided studies regarding the use of colchicine in patients with an eGFR of 29.
• However, it is mentioned that colchicine has a narrow therapeutic-toxicity window and important variability in tolerance between subjects 4.
• Low-dose colchicine (1.8 mg over 1 h) is effective in reducing pain and is well tolerated in patients with acute gout, but the study does not specify the renal function of the patients 4.
• Other treatment options for gout, such as NSAIDs and corticosteroids, may also have limitations in patients with renal impairment 3, 5.
• Urate-lowering therapies, such as allopurinol and febuxostat, may be used to prevent gout flares, but the dosing of these medications may need to be adjusted in patients with renal impairment 6, 3, 5, 7.