Low-dose Oral Colchicine in the Treatment of Patients with Acute Gout Flares—A Commentary

Abstract

Abstract
Oral colchicine has been used for centuries to reduce the severity and duration of acute gout flares. Traditional colchicine dosing every hour or two until pain relief, gastrointestinal toxicity, or attainment of a specified dose is often complicated by gastrointestinal toxicity preceding or accompanying benefit. First-time US Food and Drug Administration (FDA) approval of oral colchicine (2009) has renewed interest in the use of colchicine for acute gout and is supported by the results of a randomized placebo-controlled trial comparing the efficacy and safety of low-dose colchicine (1.2mg followed by 0.6mg one hour later), high-dose colchicine (4.8mg over six hours), and placebo in subjects with early acute flares. Although both colchicine regimens showed similar efficacy (pain relief by 24 hours), gastrointestinal toxicity with low-dose treatment was no greater than with placebo and significantly less than with high-dose treatment. These findings support the FDA recommendation for low-dose rather than high-dose colchicine when this agent is chosen for the treatment of early acute gout flares.

Keywords
Gout, colchicine, gout flare, anti-inflammatory agents, interleukin 1 (IL-1)

Disclosure: Michael A Becker, MD, is a consultant for Takeda, Savient, URL/Pharma, BioCryst, Ardea, Novartis, and Regeneron. The journal does receive proprietary interest support but, in the case of this paper, such support did not influence the choice of author invited, the content of the paper, the independent peer review process, or the editorial decisions.
Received: March 3, 2010 Accepted: March 22, 2010 Citation: US Musculoskeletal Review, 2010;5:23–28
Correspondence: Michael A Becker, MD, MC0930, University of Chicago Medical Center, 5841 South Maryland Ave, Chicago, IL 60637. E: mbecker@medicine.bsd.uchicago.edu