Issue: July 2024
Fact checked byShenaz Bagha

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May 22, 2024
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One-quarter of patients with gout receive colchicine despite potential interactions

Issue: July 2024
Fact checked byShenaz Bagha
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Key takeaways:

  • More than 25% of patients with gout who use colchicine prophylaxis were on potentially interacting medications.
  • Serious adverse events were low, though women and older adults demonstrated more GI.

Approximately 26% of patients with gout are commonly prescribed colchicine prophylaxis despite already using medications with potential interactions, according to data published in Rheumatology.

“Colchicine toxicity is theoretically increased by concomitant treatment with common drugs,” Ram Bajpai, MS, PhD, of the Keele University School of Medicine, in the United Kingdom, and colleagues wrote. “Although colchicine is contraindicated in patients taking these medications, in our clinical experience from primary and secondary care, their co-prescription still commonly occurs. However, evidence that these factors are prognostic for adverse events is largely anecdotal or theoretical, and large research studies are lacking.”

Overall, 26% of patients with gout who were prescribed colchicine prophylaxis also received at least one potentially interacting medication.
Data derived from Bajpai R, et al. Rheumatology. 2024;doi:10.1093/rheumatology/keae229.

 

To examine how co-prescriptions with colchicine impact risk for adverse events in gout, Bajpai and colleagues conducted a retrospective cohort study. Using the linked U.K. Clinical Practice Research Datalink and Hospital Episode Statistics data sets, the researchers examined 13,945 adults with gout (mean age, 63.9 years) who initiated allopurinol with colchicine prophylaxis between April 1997 and November 2016.

Follow-up lasted for 6 months or until end of colchicine treatment. The researchers calculated the proportion of patients prescribed potentially interacting drugs — defined as statins, fibrates, verapamil, diltiazem, digoxin, amiodarone, oral ketoconazole and macrolide antibiotics — in the 30 days before index. They also estimated the risk for adverse events, including diarrhea, nausea or vomiting, myocardial infarction, neuropathy, myalgia, myopathy, rhabdomyolysis and bone marrow suppression.

Overall, 26% (95% CI, 25%-27%) of patients were prescribed at least one potentially interacting medication, according to the researchers. The most frequent were statins (21%; 95% CI, .2-.22), followed by digoxin, diltiazem and macrolide antibiotics. Statins were not linked to increased adverse events, except atorvastatin, which was linked with myocardial infarction (HR = 2.21; 95% CI, 1.14-4.27).

Patterns of adverse events included “generally higher” diarrhea, nausea and vomiting among women and older adults, as well as more myocardial infarctions at older ages, the researchers wrote. Per 10,000 person-years, the most common adverse events were diarrhea with fibrate prescription (4,322.8; 95% CI, 2,161.8-8,664), myalgia with verapamil prescription (2,873.7; 95% CI, 404.8-20,000) and diarrhea with macrolide antibiotics (2,855.3; 95% CI, 1,361.2-5,989.3).

“We found that people were given colchicine prophylaxis despite commonly having preexisting prescriptions for medications with potential to interact with colchicine,” Bajpai and colleagues wrote. “Adverse events were more common in people who were older, had more comorbidities and were prescribed certain potentially interacting medications.

“Reassuringly, the rate of serious adverse events was low, providing reassurance for people with gout and for clinicians,” they added. “We also found no evidence that the prescription of statins significantly increased the risk of adverse events except atorvastatin being associated with MI.

“Reassuringly, the rate of serious adverse events was low,” Bajpai and colleagues wrote. “We also found no evidence that the prescription of statins significantly increased the risk of adverse events except atorvastatin being associated with MI. ... Our findings will provide much-needed information about the safety of flare prophylaxis that can inform treatment decisions when initiating allopurinol, directly benefiting people with gout and their clinicians.”