Gout Flare Prophylaxis - Colchicine or NSAIDs? Save

Flare prophylaxis is the standard when initiating urate-lowering therapy (ULT) in patients with gout. A new study suggests that colchicine, more so than non-steroidal anti-inflammatory drug (NSAID) prophylaxis, may increase the odds of adverse events, when initiating allopurinol for gout.

A matched retrospective cohort study, using data from the UK Clinical Practice Research Datalink and Hospital Episode Statistics datasets, examined adults starting ULT with allopurinol for gout and who either received no prophylaxis or colchicine or NSAID. 

They identified 13 945 allopurinol-initiating gout patients who were given colchicine ; these were matched to 13 945 with no prophylaxis. Similarly, 25 980 prescribed NSAID to were matched with 25 980 patients taking no prophylaxis.  The use of corticosteroids as prophylaxis was not studied. 

Overall, adverse event incidence rates were  seen <200 per 10 000 patient-years, except:

• NSAID had more angina (466.6/10K PYs)  
  • Not significant: NSAID related AE risk for Nausea/Vomiting, angina, acute kidney injury, MI, peptic ulcer disease and any AE,
• Colchicine had more diarrhea (784.4/10K PYs) and nausea (208.1/10K PYs)
  • Significantly higher AE Risk with colchicine (vs. no prophylaxis) for:
    • Diarrhea (HR 2.22)
    • Myocardial infarction (MI) (HR 1.55)
    • Neuropathy (HR 4.75)
    • Myalgia (HR 2.64)
    • Bone marrow suppression (HR 3.29)
    • and any adverse event (HR 1.91)

Adverse events may occur w/ the use of NSAIDs or colchicine as flare prophylaxis during ULT, but compared to no prophylaxis, only colchcine significantly increased the risk of adverse events, particularly diarrhoea 

While both colchicine and NSAID reduces the incidence of gout flares, the potential for AEs needs to be discussed with and tailored to the patient.