Can colchicine be given to patients with Crohn's (Crohn's disease)?

Colchicine Use in Crohn's Disease

Colchicine is not recommended for patients with Crohn's disease due to lack of evidence supporting its efficacy and potential for gastrointestinal side effects that could exacerbate disease symptoms.

Evidence Against Colchicine Use in Crohn's Disease

• Current clinical guidelines for the management of Crohn's disease do not include colchicine as a recommended treatment option for either induction or maintenance therapy 1
• The European Crohn's and Colitis Organisation (ECCO) guidelines specifically recommend corticosteroids, immunomodulators, and biologics as the mainstay treatments for Crohn's disease flares and maintenance, with no mention of colchicine 2, 1
• The Canadian Association of Gastroenterology guidelines for pediatric Crohn's disease focus on enteral nutrition, corticosteroids, immunomodulators, and biologics without including colchicine in their treatment algorithms 2

Potential Risks of Colchicine in Crohn's Disease

• Colchicine commonly causes gastrointestinal adverse effects including diarrhea (reported in 17.9% of users versus 13.1% in control groups) and other gastrointestinal events (17.6% versus 13.1%) 3
• These gastrointestinal side effects could potentially worsen symptoms in patients with Crohn's disease, whose primary disease manifestations often include diarrhea and abdominal pain 1
• Long-term colchicine use has been associated with mild steatorrhea and enzyme inhibition in the gastrointestinal tract, which could further compromise digestive function in Crohn's patients 4
• Histological changes in the gastric antrum have been observed in patients on colchicine therapy, including metaphase mitoses, epithelial pseudoproliferation, and mucin depletion 5

Established Treatment Options for Crohn's Disease

• First-line treatments for Crohn's disease flares include corticosteroids (budesonide 9 mg/day for disease limited to ileum/ascending colon or systemic corticosteroids for more extensive disease) 1
• Maintenance therapy after achieving remission should include biologics (TNF inhibitors) with or without immunomodulators, or thiopurines (azathioprine, mercaptopurine) or methotrexate 1
• Mesalazine (5-ASA) is not recommended for induction or maintenance of remission in Crohn's disease 2, 1

Limited Evidence for Colchicine in Other Inflammatory Conditions

• While colchicine has established efficacy in conditions like gout, Behçet's disease, and familial Mediterranean fever, there is no substantial evidence supporting its use in Crohn's disease 6
• In the North American Clinical Management Guidelines for Hidradenitis Suppurativa, weak evidence supports the use of colchicine only in combination with minocycline for refractory mild-to-moderate disease, but not as monotherapy 2
• The EULAR recommendations for calcium pyrophosphate deposition note that colchicine at 0.5 mg up to 3-4 times daily may be used for acute attacks of crystal arthritis, but make no mention of inflammatory bowel disease 2

Conclusion

Based on the available evidence and clinical guidelines, colchicine should not be given to patients with Crohn's disease due to:

• Absence of supporting evidence for efficacy in Crohn's disease 2, 1
• High risk of gastrointestinal side effects that could exacerbate Crohn's disease symptoms 4, 5, 3
• Availability of other evidence-based treatment options with established efficacy and safety profiles in Crohn's disease 1