‘Potential added benefit’: Colchicine lowers risk for knee, hip replacement in gout
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WASHINGTON — The use of colchicine for gout flare prevention imparts a “modest” decrease in the risk for knee or hip replacement over several years, according to a study presented at ACR Convergence 2024.
The study followed up on the LoDoCo2 trial, in which researchers first reported a signal of benefit with colchicine regarding joint replacement.
“The LoDoCo2 trial, a cardiovascular trial, demonstrated a lower risk for knee and hip replacement in the colchicine arm compared with the placebo in a post hoc analysis,” Tuhina Neogi, MD, PhD, chief of rheumatology, and Alan S. Cohen professor of rheumatology, at the Boston University School of Medicine and Boston Medical Center, told Healio. “This was an intriguing observation and raised the question of whether colchicine may have structural benefits for conditions such as gout and OA.
“Given that colchicine is not used in clinical practice for OA, we could not use real-world evidence to examine colchicine’s effects on joint replacement in people with OA,” she added. “Instead, we examined this question in people with gout, since colchicine is commonly prescribed in gout, and people with gout have higher rates of joint replacement than the general population.”
To assess the impact of colchicine on the risk for knee or hip replacement, Neogi and colleagues used data from the IQVIA Medical Record Database to conduct a population-based cohort study of adults with gout from January 2000 through December 2021. The researchers included 31,651 patients who initiated colchicine (mean age, 59.6 years) and an equal number of patients who did not (mean age, 60.2 years), followed for a median of 4.5 years and 4.3 years, respectively.
The researchers used Cox proportional hazards regression to compare the risk for knee or hip replacement among patients on colchicine vs. those not on colchicine.
Overall, 3.3% of patients on colchicine and 3.7% of those not on colchicine underwent knee or hip replacement during the study period, with incidence rates of 6.55 per 1,000 person-years and 7.66 per 1,000 person-years, respectively. Compared with patients not using colchicine, those taking colchicine demonstrated a “modest” decrease in the risk for knee or hip replacement (HR = 0.86; 95% CI, 0.79-0.93), even after additional adjusting for confounding variables (HR = 0.87; 95% CI, 0.8-0.95), according to the researchers.
Colchicine’s cardiovascular benefits, plus its potential to curb joint replacement risk among patients with gout, suggest the duration of its use as gout flare prophylaxis “may merit reconsideration,” the researchers wrote.
“Presently, colchicine is only recommended for use in gout for a relatively short time as prophylaxis when initiating urate-lowering therapy, or is used intermittently to treat flares,” Neogi said. “Now that the cardiovascular benefits of colchicine noted in the LoDoCo2 trial has led to a new formulation of colchicine (LoDoCo) to be FDA-approved for cardiovascular disease, and the fact that cardiovascular disease is a common comorbidity among people with gout, colchicine may be considered for longer term use among people with both gout and cardiovascular disease.
“With the potential benefit of colchicine also reducing the need for joint replacement, this provides additional consideration for colchicine to be used for longer durations in people with gout for this potential added benefit,” she added. “Of course, the long-term safety of colchicine use will need to be considered, particularly in the context of relevant drug interactions and renal insufficiency.”
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Neogi T. Abstract #2557. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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