Best of 2023: Colchicine or Prednisone in CPPD? Save

Editor's note: this article originally appeared August 9, 2023, and is being shared again as a Best of 2023. Enjoy!

The COLCHICORT trial in patients with acute calcium pyrophosphate crystal arthritis (CPPD) demonstrated equivalent efficacy for both colchicine and prednisone, yet different safety signals were seen.

An open-label, multicentre, randomised, trial (COLCHICORT) from six hospitals in France compared the safety and efficacy of low-dose colchicine vs. oral prednisone in older (>65 yrs) patients with acute CPPD arthritis with a symptom duration of less than 36 hours. A CPPD diagnosis was confirmed by the identification of calcium pyrophosphate crystals on synovial fluid analysis or typical clinical presentation (onset of joint pain and swelling. 

A total of 111 acute CPPD arthritis patients were enrolled and randomized to receive either colchicine (1.5 mg on day 1 and 1 mg on day 2 (COL group) or oral prednisone 30 mg on days 1 and 2 (PRED group). The primary outcome was change in joint pain (measured by visual analogue scale [VAS] from 0 mm to 100 mm) at 24 h.

The final per-protocol analysis included 95 patients (49 COL vs 46 PRED). The median age was 88 years. Most were women and 27% were men.  Affected joints included the knee (48%), wrist (20%), and ankle (13%). The baseline pain 68 mm (VAS).

The 24 hour results showed change in pain (VAS) to be: 

• COL –36 mm (SD 32)
• PRED –38 mm (SD 23)

Side effects differed between cohorts:

• COL: 22% diarrhea, 2% hypertension, none with hyperglycemia. No deaths occurred in the COL group
• PRED: 6% diarrhea, 11% hypertension, 6% hyperglycemia. Ttwo deaths PRED group (deemed unrelated; infectious valvular endocarditis; CVA)

While colchicine and prednisone are similar in efficacy for acute calcium pyrophosphate crystal arthritis: however, more diarrhea with colchicine use.