Colchicine for Recurrent Aphthous Stomatitis
Colchicine is an effective treatment option for recurrent aphthous stomatitis, particularly for severe or frequent cases that do not respond to topical therapies. Based on available evidence, colchicine demonstrates significant efficacy in reducing both the frequency and severity of aphthous ulcers.
Efficacy of Colchicine for Aphthous Stomatitis
- Open trial data shows colchicine is effective in approximately 63% of patients after 3 months of treatment, with sustained improvement in 37% of patients during long-term follow-up 1
- Colchicine (1.5 mg/day) can reduce the number of aphthae per week by 71% and subjective pain scores by 77% compared to no treatment 2
- Treatment dosage typically ranges from 1.0-1.5 mg/day for at least 3 months 1
Treatment Algorithm for Aphthous Stomatitis
- First-line therapy: Topical agents (corticosteroids, antimicrobials, or over-the-counter preparations like amlexanox) 3
- Second-line therapy: For severe, recurrent, or topical-resistant cases:
- Colchicine: 1.0-1.5 mg/day
- Prednisolone: 5 mg/day (alternative with fewer side effects) 4
Comparative Efficacy
When directly compared to prednisolone (5 mg/day), colchicine (0.5 mg/day) shows:
- Similar efficacy in reducing lesion size and number
- Similar reduction in pain severity and recurrence rates
- Similar duration of pain-free periods
- However: Significantly more side effects with colchicine (52.9%) compared to prednisolone (11.8%) 4
Monitoring and Side Effects
- Common side effects of colchicine include:
- Gastrointestinal issues (diarrhea, nausea, vomiting, abdominal cramping)
- Less commonly: headache and fatigue 5
- Colchicine is contraindicated in patients with:
- Renal or hepatic impairment
- Patients using potent cytochrome P450 3A4 inhibitors or P-glycoprotein inhibitors 5
- For patients with renal impairment, dose adjustment is necessary:
- Moderate impairment: Initial dose of 0.6 mg for acute flares, not repeated more than once every two weeks 6
Important Considerations
- Treatment response should be assessed after 3 months of continuous therapy 1
- Upon discontinuation, recurrences may occur rapidly (within 3 days in some cases) 7
- For patients with Behçet's syndrome (which can present with aphthous stomatitis), colchicine is specifically recommended for mucocutaneous manifestations 5
Special Populations
- In patients with chronic kidney disease, colchicine dosing should be reduced:
- CrCl 10-20 mL/min: 200 mg/day maximum
- CrCl <10 mL/min: ≤100 mg/day maximum 6
- Avoid colchicine in patients with severe renal or hepatic impairment
While both colchicine and low-dose prednisolone (5 mg/day) demonstrate similar efficacy in treating recurrent aphthous stomatitis, the higher rate of side effects with colchicine suggests that prednisolone may be preferable for many patients. However, for patients who cannot tolerate or have contraindications to corticosteroids, colchicine remains a valuable therapeutic option.