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Colchicine or Prednisone in CPPD?

Aug 09, 2023 5:23 pm

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.


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The author has no conflicts of interest to disclose related to this subject