Low-Dose Colchicine Well Tolerated for Managing Crystal-Induced Arthritis Flares in Patients With Severe CKD – Renal and Urology News

Colchicine may be used with caution to manage flare-ups of crystal-induced arthritis among patients with severe chronic kidney disease (CKD), with dosage modifications and careful monitoring required, according to study results published in Rheumatic and Musculoskeletal Diseases Open.

The European Alliance of Associations for Rheumatology (EULAR) recommends gout management with colchicine, nonsteroidal anti-inflammatory drugs, and glucocorticoids as first-line options, while results of the Acute Gout Flare Receiving Colchicine Evaluation trial demonstrated the safety of low-dose colchicine. Managing gout in patients with CKD presents challenges, especially with the scarcity of data on colchicine use due to contraindications.

To this aim, investigators conducted a single-center prospective study from September 2020 to September 2021, including hospitalized patients with crystal-induced arthritis and severe CKD who received colchicine. The investigators assessed the safety and efficacy of colchicine for managing gout or calcium pyrophosphate deposition (CPPD) disease flares in patients with severe CKD.

Patients with stage G4 (estimated glomerular filtration rate [eGFR] 15-30 mL/min) or G5 (eGFR <15 mL/min) CKD, as well as those on dialysis, were categorized as having severe disease. Patients with acute renal failure who did not have severe CKD were excluded.

Clinical trials in this population could be of interest, to evaluate the use of colchicine in prophylaxis for long-term gout flares and thus avoid the recurrence of flare when urate-lowering therapies are initiated.

A total of 54 patients who received 62 prescriptions for colchicine (cases) were included in the final analysis, involving 58 prescriptions for gout flares, 1 case of CPPD, and 3 cases of both conditions. The majority of patients were men (66.7%) with a median age of 75 years.

The predominant colchicine dosage was 0.5 mg/day or less in 75.8% of cases, with no dosages exceeding 1 mg/day. Treatment initiation occurred on the same day as symptoms in 61.4% of cases or the following day in 19.3% of cases.

Overall, 22% of patients underwent dialysis, with hospitalizations mainly attributed to heart failure (31.5%), acute renal failure (22.2%), infection (18.5%), or an acute joint episode (9.3%).

In general, colchicine was well tolerated by the majority of patients (77%), with no reports of serious adverse events. The investigators deemed colchicine fully effective in 83% of patients.

Clinician-reported adverse events included diarrhea (13%), vomiting (5%), and aggravation of pre-existing leucopenia (2%).

Study limitations included heterogeneity in colchicine dosages, the limited patient sample size, follow-ups via phone without new data for early discharges, and subjective pain assessments.

“Longer term data exploring the efficacy and safety of colchicine use as a prophylactic treatment would be interesting,” the study authors noted. “Clinical trials in this population could be of interest, to evaluate the use of colchicine in prophylaxis for long-term gout flares and thus avoid the recurrence of flare when urate-lowering therapies are initiated,” they concluded.

This article originally appeared on Rheumatology Advisor

References:

Bausson J, Keller N, Von Hunolstein JJ, et al. Safety and efficacy of colchicine in crystal-induced arthritis flare in 54 patients with severe chronic kidney disease. RMD Open. Published online January 31, 2024. doi:10.1136/rmdopen-2023-003872