“The outcome of this was very clear—the patients who got the low dose had, in essence, as good an effect as the high dose and as safe an effect as the placebo,” Dr. Pillinger explained. “This specifically applies to patients who got treated early.” Of note, he added, colchicine was only about 40% effective.
Another study using colchicine as the control drug showed a similar efficacy rate.3 “The point [of the Schlesinger study] was that even prophylaxing, patients may get gout attacks. It’s a good drug, but it’s not a perfect drug,” he said.
As indicated in the ACR guidelines for gout, one way to increase efficacy of colchicine as a first-line treatment for acute gout is to add nonsteroidal antiinflammatory drugs and prednisone.
“If in gout, colchicine is a pretty good drug, then in familial Mediterranean fever, colchicine is a great drug. It has changed people’s lives and survival,” Dr. Pillinger said. He cited some older studies with “dramatic results” that showed about 90% of patients who were compliant with the drug regimen avoided inflammatory attacks and amyloidosis.
There is also some early evidence that colchicine may have application in OA, an inflammatory disease in which IL-1 and urate may be important, Dr. Pillinger said. There is a link between gout and increased prevalence and severity of OA, and two small trials suggest colchicine may help alleviate pain in patients with OA.
Cardiovascular Disease
The potential therapeutic value of colchicine in cardiovascular disease is a subject that rheumatologists and researchers are trying to understand better, Dr. Pillinger said. One thought is that the antiinflammatory action of colchicine may reduce the risk of myocardial infarction. In one study, gout patients taking colchicine exhibited a nearly 50% reduction in the incidence of myocardial infarction.4 There were also trends toward lower c-reactive protein and a reduced risk of death.
Further support for this connection is the CONSORT study, which involved 500 non-gout patients with preexisting cardiovascular disease. The trial demonstrated that patients taking 0.5 mg/d of colchicine or placebo for at least two years had about a 65% lower risk of any acute coronary syndrome, heart attack or stroke, Dr. Pillinger said.
“Gout is a disease of inflammation, and while the inflammation in gout may be more intermittent than in RA, gout patients are still known to harbor an increased risk of cardiovascular disease,” Dr. Pillinger said. “If this is an inflammatory disease, maybe controlling the inflammation in gout might decrease the risk of cardiovascular disease in these patients.”
