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Prophylactic colchicine for chronic gout

 

Clinical bottom line

On the basis of a single small trial, prophylactic use of colchicine reduces the number of attacks of acute gouty arthritis when added to uric acid lowering therapy


Reference

HE Paulus et al. Prophylactic colchicine therapy of intercritical gout. A placebo-controlled study of prebenecid-treated patients. Arthritis and Rheumatism 1974 17: 609-614.

Study

This was a properly randomised and double-blind study of men with serum uric acid levels of more than 7.5 mg/dL (440 µmol/L) and acute gouty arthritis that responded to intensive colchicine therapy. The main exclusion was known renal disease.

Treatment was with 500 mg probenecid, or 500 mg probenecid plus 0.5 mg colchicine three times a day for six months. Only men who clearly showed and maintained reduction in serum uric acid were included in the analysis (38 of 52 men).

Results

The two groups were well matched, has an average age of 53 years, with a duration of gout of 11 years, and with an average initial serum uric acid of about 9 mg/dL (530 µmol/L).

Serum uric acid fell to an average of 6.3 mg/dL in both groups. In those not receiving additional colchicine, there were 0.5 attacks per month (one attack every two months). In those receiving colchicine, there were 0.2 attacks per month (one attack every five months). The difference was significant at the 1 in 100 level. Similar results were found in an analysis of the 18 men whose serum urate was below 6.5 mg/dL (380 µmol/L).

There were more gastrointestinal adverse events with colchicine, but this did not reach a statistically significant level.

Comment

Despite its small size, this was a well conducted study, and the only one found (so far) that investigated prophylactic colchicine in addition to urate lowering therapy.