From the Guidelines
Colchicine can be combined with prednisone, particularly for gout attack prophylaxis, as an alternative strategy in patients with intolerance or contra-indication to colchicine and NSAIDs. According to the 2012 American College of Rheumatology guidelines for management of gout, the use of low-dose prednisone or prednisolone (defined as ≤10 mg/day) is recommended as an alternative gout attack prophylaxis strategy in patients who cannot tolerate or have contraindications to both colchicine and NSAIDs 1. When combining colchicine with prednisone, it is essential to monitor patients for potential side effects, such as gastrointestinal issues, and to adjust doses according to renal function impairment. Some key points to consider when combining these medications include:
- Colchicine is typically prescribed at low doses (0.5 mg or 0.6 mg orally once or twice a day) for gout attack prophylaxis, with dosing adjustments for moderate to severe renal function impairment and potential drug-drug interactions 1.
- Prednisone doses for gout attack prophylaxis are recommended to be low (≤10 mg/day) due to the known risks of prolonged use of corticosteroids 1.
- The combination of colchicine and prednisone provides complementary anti-inflammatory effects, with colchicine preventing neutrophil activation and migration to inflamed areas, and prednisone reducing overall inflammation through multiple pathways. It is crucial to weigh the benefits and risks of this combination, particularly considering the potential side effects of long-term prednisone use, such as immunosuppression, weight gain, and bone density loss, and the rare but serious side effects of colchicine, including muscle weakness and bone marrow suppression 1.
From the Research
Combination of Colchicine and Prednisone
- The combination of colchicine and prednisone has been studied in various clinical trials for the treatment of different diseases, including primary sclerosing cholangitis 2, acute calcium pyrophosphate crystal arthritis 3, idiopathic pulmonary fibrosis 4, sclerosing mesenteritis 5, and recurrent aphthous stomatitis 6.
- In a study on primary sclerosing cholangitis, the combination of colchicine and prednisone showed a trend toward less clinical deterioration and improved survival after 2 years of treatment, but did not retard histologic progression or progression of standard liver tests 2.
- For acute calcium pyrophosphate crystal arthritis, colchicine and prednisone exhibited equivalent short-term efficacy, with different safety profiles in the older population 3.
- In the treatment of idiopathic pulmonary fibrosis, the combination of colchicine and/or D-penicillamine with prednisone did not show significant differences in lung mechanics or arterial gases compared to prednisone alone 4.
- The combination of corticosteroids and colchicine was found to be helpful in the management of symptomatic sclerosing mesenteritis, with rapid improvement in two patients 5.
- For recurrent aphthous stomatitis, both colchicine and prednisolone were effective in reducing the signs and symptoms of the disease, but colchicine was associated with more side effects 6.
Safety and Efficacy
- The safety and efficacy of combining colchicine and prednisone vary depending on the disease being treated and the patient population.
- In general, the combination of colchicine and prednisone may be associated with more side effects, such as diarrhea, hypertension, and hyperglycemia, compared to prednisone alone 3, 6.
- However, the combination may also provide benefits in terms of reduced clinical deterioration and improved survival in certain diseases, such as primary sclerosing cholangitis 2.