{"id":2549,"date":"2016-05-11T16:49:01","date_gmt":"2016-05-11T21:49:01","guid":{"rendered":"http:\/\/www.charleswmoore.org\/wordpress\/?p=2549"},"modified":"2016-05-11T16:49:01","modified_gmt":"2016-05-11T21:49:01","slug":"colchicine-for-gout-treatment","status":"publish","type":"post","link":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/2016\/05\/11\/colchicine-for-gout-treatment\/","title":{"rendered":"Colchicine for Gout Treatment"},"content":{"rendered":"

I found this very interesting article and the surprise in the concluding paragraph. \u00a0The URL to the subject is\u00a0http:\/\/www.hopkinsarthritis.org\/arthritis-news\/gout-news\/arthritis-news-optimal-colchicine-dosage-for-acute-gout-explored\/<\/a>. \u00a0The article, in part, concluded, from editorial comment, \u00a0that lowering serum levels may be a more effective treatment than anything but low doses of Colchicine (two 0.6 Mg then one 0.6 mg later). \u00a0Please read the article copied from the above link to form your on opinion. A big thanks to the researchers for this study.<\/p>\n

\n

Quote<\/h1>\n

Optimal Colchicine Dosage for Acute Gout Explored<\/h1>\n

Jon Giles, MD<\/span><\/a><\/span><\/p>\n<\/header>\n

\n
\"Gout\"<\/p>\n

Gout<\/p>\n<\/div>\n

Despite being used for decades as a primary treatment for acute gout, optimal colchicine dosing has not been systematically evaluated.\u00a0 This is potentially important, as higher doses of colchicine can frequently be associated with the undesired consequence of severe diarrhea and gastrointestinal distress.\u00a0 Here, Terkeltaub et al (Arthritis Rheum 2010; 62(4): 1060) explore different dosing strategies for colchicine in the first randomized, blinded, placebo controlled trial, named AGREE (Acute Gout Flare Receiving Colchicine Evaluation)<\/p>\n

Methods<\/h2>\n

Adult men and postmenopausal women with confirmed gout and a history of frequent flares were randomized to one of three treatment groups:<\/p>\n

    \n
  1. low dose colchicine- 1.2 mg followed by 0.6 mg in one hour (followed by placebo doses on subsequent hours): total dose=1.8 mg<\/li>\n
  2. high dose colchicine \u2013 1.2 mg followed by 0.6 mg per hour for 5 hours: total dose 4.8 mg<\/li>\n
  3. all placebo<\/li>\n<\/ol>\n

    Participants were enrolled at 54 centers in the U.S. in 2007-2008.\u00a0 Patients used supplied study medications within 12 hours of the onset of flare symptoms, with symptoms monitored in a diary.\u00a0 Post-flare study visits were planned for within 48 hours of flare onset.\u00a0 The primary endpoint was the proportion of patients with a 50% or greater reduction in pain within 24 hours of study drug.<\/p>\n

    Results<\/h2>\n

    Among the 575 randomized patients, 185 had a gout flare and used the study medication.\u00a0 There were 52 (28%) in the high dose group, 74 (40%) in the low dose group, and 59 (32%) in the placebo group.\u00a0 Mean age was 52 years, with the majority of participants being male (95%), Caucasian (83%), with longstanding gout.\u00a0 Tophi were uncommon (9%).\u00a0 Despite a mean serum urate concentration of 8.8 mg\/dl, less than a third were receiving urate lowering therapy.<\/p>\n\n\n\n\n\n\n\n\n
    Table. Efficacy Outcomes According to Treatment Allocation<\/td>\n<\/tr>\n
    <\/td>\n\n

    High Dose
    \n(n=52)<\/p>\n<\/td>\n

    		\n

    Low Dose
    \n(n=74)<\/p>\n<\/td>\n

    		\n

    Placebo
    \n(n=58)<\/p>\n<\/td>\n

    		\n

    p-value high dose vs. placebo<\/p>\n<\/td>\n

    		\n

    p-value
    \nlow dose vs. placebo<\/p>\n<\/td>\n<\/tr>\n

    \u00a050% reduction in pain at 24 hours<\/td>\n\n

    33%<\/p>\n<\/td>\n

    		\n

    38%<\/p>\n<\/td>\n

    		\n

    16%<\/p>\n<\/td>\n

    		\n

    0.034<\/p>\n<\/td>\n

    		\n

    0.005<\/p>\n<\/td>\n<\/tr>\n

    \u2265 50% reduction in pain at 32 hours<\/td>\n\n

    37%<\/p>\n<\/td>\n

    		\n

    42%<\/p>\n<\/td>\n

    		\n

    17%<\/p>\n<\/td>\n

    		\n

    0.022<\/p>\n<\/td>\n

    		\n

    0.002<\/p>\n<\/td>\n<\/tr>\n

    \u2265 2 unit reduction in pain at 24 hours<\/td>\n\n

    35%<\/p>\n<\/td>\n

    		\n

    43%<\/p>\n<\/td>\n

    		\n

    17%<\/p>\n<\/td>\n

    		\n

    0.037<\/p>\n<\/td>\n

    		\n

    0.002<\/p>\n<\/td>\n<\/tr>\n

    \u2265 2 unit reduction in pain at 32 hours<\/td>\n\n

    39%<\/p>\n<\/td>\n

    		\n

    46%<\/p>\n<\/td>\n

    		\n

    17%<\/p>\n<\/td>\n

    		\n

    0.012<\/p>\n<\/td>\n

    		\n

    0.001<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Rescue medications were used significantly less frequently in the colchicine groups, and did not differ by low-dose vs. high-dose allocation.<\/p>\n

    For safety, there were no serious adverse events.\u00a0 Diarrhea was observed in 77% of high dose colchicine treated patients compared to 23% of low-dose and 14% of placebo treated patients.\u00a0 Severe diarrhea was observed in 19% of high dose patients, compared to none in the other groups.\u00a0 Vomiting was only observed in the high dose colchicine group.\u00a0 These differences were all statistically significant.<\/p>\n

    Conclusions<\/h2>\n

    Low dose colchicine was as efficacious as high dose in relieving the pain of recurrent gout flares with a more favorable side effect profile.<\/p>\n

    Editorial Comment<\/h2>\n

    Colchicine has been widely used to treat acute gout for decades, yet its usage has been based primarily on style than hard data.\u00a0 This study definitively supports the use of this low dose regimen over higher doses.\u00a0 Even with higher doses, more than 60% of patients did not have at least a 50% reduction in the their symptoms in the first 24-32 hours.\u00a0 This suggests that chronic urate lowering, rather than flare management, should be the focus of care in patients with frequent attacks, a modality that was absent in many of these patients.\u00a0 Whether other treatments for acute gout (i.e. NSAIDs or glucocorticoids) are superior to this regimen has not been studied.<\/p>\n

    End Quote<\/h1>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    I found this very interesting article and the surprise in the concluding paragraph. \u00a0The URL to the subject is\u00a0http:\/\/www.hopkinsarthritis.org\/arthritis-news\/gout-news\/arthritis-news-optimal-colchicine-dosage-for-acute-gout-explored\/. \u00a0The article, in part, concluded, from editorial comment, \u00a0that lowering serum levels may be a more effective treatment than anything but low doses of Colchicine (two 0.6 Mg then one 0.6 mg later). \u00a0Please read the […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/posts\/2549"}],"collection":[{"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/comments?post=2549"}],"version-history":[{"count":1,"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/posts\/2549\/revisions"}],"predecessor-version":[{"id":2550,"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/posts\/2549\/revisions\/2550"}],"wp:attachment":[{"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/media?parent=2549"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/categories?post=2549"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.charleswmoore.org\/wordpress\/index.php\/wp-json\/wp\/v2\/tags?post=2549"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}