Benefit of low-dose colchicine for acute gout
Cochrane Pre-hospital and Emergency Care
Benefit of low-dose colchicine for acute gout
McKenzie BJ, Wechalekar MD, Johnston RV, Schlesinger N, Buchbinder R. (2021)
Colchicine for acute gout
Cochrane Database Syst Rev, 8, CD006190.
CONTEXT
Gout is one of the most common rheumatic diseases worldwide. Colchicine is the first-line treatment but evidence on its dosage, benefits and harms is limited.
CLINICAL QUESTION
How effective is colchicine for acute gout compared to placebo or other treatments for pain, inflammation and target joint function? What are the adverse events (AEs) and serious adverse events (SAEs) of this treatment?
BOTTOM LINE
Compared to placebo, low-dose colchicine may be more effective in reducing pain within 32-36 h (low level of evidence) with few or no AEs (low level of evidence). Inflammation and function of target joint were not assessed. At high-doses, colchicine may reduce pain and inflamation at the cost of a significant increase in AEs (low level of evidence). Pain and function of target joint have not been evaluated.
One trial compared low-dose to high-dose colchicine. Efficacy was similar but at the cost of more AEs with high-dose colchicine. Another trial compared low-dose colchicine with non-steroidal anti-inflammatory drugs (NSAIDs). Efficacy was comparable in terms of pain reduction at 7 days. There was no significant difference in the number of AEs reported. Finally, a trial comparing Chuanhu mixture with low-dose colchicine showed that the frequency of acute gout was comparable. However, the occurrence of AEs appears to be more frequent with low-dose colchicine without being responsible for premature treatment discontinuation.
CAVEATS
This review was unable to estimate the risk of AEs for most comparisons because few events were reported in the trials. Given the low level of evidence in this meta-analysis, it is very likely that future studies will change the outcome.
Pragmatic studies taking into account the patient's profile, co-morbidities and assessing in particular the frequency of acute gout, pain and uric acid concentration should help to identify the most appropriate treatment for each patient (low-dose colchicine, NSAIDs or corticosteroid infiltration).
AUTHORS
Y. Auffret
Département de médecine d’urgence (SAU, Samu 29, SMUR)
F-29200 Brest, France
D. Meyran
Groupement Santé, SMUR
Bataillon de Marins Pompiers de Marseille.
F-13003, Marseille, France
K. Magee
Kirk.magee@dal.ca
Dalhousie University, Halifax Infirmary
Nova Scotia, Canada
