Colchicine curbs cardiovascular event risk when used with urate-lowering therapy for gout
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Key takeaways:
- Patients taking colchicine had a weighted hazard ratio of 0.82 (95% CI, 0.69-0.94) for cardiovascular events.
- The effect was consistent regardless of cardiovascular disease and analytical methods.
Colchicine for gout flare prophylaxis reduces the risk for cardiovascular events among patients initiating urate-lowering therapy, according to data published in The Lancet Rheumatology.
“Cardiovascular events have been previously reported to be temporally associated with recent previous gout flares (ie, those within the previous 60 days),” Edoardo Cipolletta, MD, an international research fellow at the University of Nottingham, in the United Kingdom, and colleagues wrote. “Given this finding and the fact that starting urate-lowering therapy can trigger gout flares, determining if flare prophylaxis using colchicine prevents cardiovascular events in those who are newly prescribed urate-lowering therapy is important.”
To probe that question, Cipolletta and colleagues analyzed U.K. primary care data from the Clinical Practice Research Datalink Aurum, with linked hospitalization and mortality records. The study included 99,800 patients with gout (25.6% women; mean age, 62.8 years), 16,028 of whom were prescribed at least 21 days of colchicine on the same date as urate-lowering therapy, while 83,772 were not prescribed colchicine or an NSAID.
Among patients prescribed colchicine, the mean duration of prophylaxis was 47.3 days. The primary outcome was fatal or non-fatal myocardial infarction or stroke within 180 days of initiating urate-lowering therapy.
The researchers balanced covariates between the groups using propensity score overlap weighting. In both intention-to-treat and per-protocol analyses, Cox proportional hazards models were used to investigate links between colchicine prophylaxis and cardiovascular events.
According to the researchers, patients prescribed colchicine were at significantly lower risk for cardiovascular events, with a weighted rate of 28.8 events (95% CI, 25.2-33.2) per 1,000 person-years, compared with 35.3 events (95% CI, 33-37.9) per 1,000 person-years among those not prescribed prophylaxis. Across 7,700.4 person-years, the colchicine group demonstrated a weighted hazard ratio of 0.82 (95% CI, 0.69-0.94) for cardiovascular events in an intention-to-treat analysis.
Overall, however, the effects of prophylaxis “appeared to be consistent” regardless of cardiovascular disease, use of intention-to-treat vs. per-protocol analysis, and across various stratifications, the researchers wrote.
“In patients with gout initiating urate-lowering therapy, gout flare prophylaxis with colchicine was associated with a lower rate of cardiovascular events for up to the next 180 days compared with no prophylaxis,” Cipolletta and colleagues wrote. “These findings provide an additional argument for using gout flare prophylaxis when starting urate-lowering therapy. In countries in which colchicine is licensed for cardiovascular disease prevention, the findings of our study and previously published studies support consideration for the use of colchicine in people with gout and cardiovascular diseases.
“These findings could be confirmed in an adequately powered randomized controlled trial,” they added. “However, such a trial would be practically prohibitive because withholding colchicine flare prophylaxis from people starting urate-lowering therapy as is recommended in rheumatology clinical practice guidelines is unethical, even though there is limited supporting evidence.”
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