Colchicine for the treatment of gout.
BACKGROUND
Colchicine, used for a long period in gout, was approved for the first time in 2009 by the FDA for the prophylaxis and the treatment of acute attack, on the basis of a pivotal trial that showed the efficacy in the very short term - that is 24 h of a well-tolerated, low-dose regimen of Colcrys (colchicine, URL Pharma, Philadelphia, USA) to reduce pain in patients with acute gout - when given early.


METHODS
We searched the Cochrane Library and Medline for articles published in English from January 2000 to August 2010 using the following search terms: colchicine, gout, efficacy, toxicity, drug interaction. Some information from the FDA was also included because it provides comprehensive overviews that are within the scope of this review.


RESULTS
Colchicine is a drug with a narrow therapeutic-toxicity window and with an important variability in tolerance between subjects. This paper reviews recent important findings on its pharmacology and efficacy which will allow a better use of this drug for the treatment of acute attack of gout. Also, pharmacokinetic, drug interaction and toxicity of colchicine are discussed.


CONCLUSIONS
Low-dose colchicine (1.8 mg over 1 h) taken as early as possible ('pills in the pocket') is effective in reducing pain and is well tolerated in patients with acute gout.
Fédération de Rhumatologie, Hôpital Lariboisière, Paris, France. pascal.richette@lrb.aphp.fr
Pascal
P
Richette
Thomas
T
Bardin
D003078:Colchicine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D006073:Gout / Q000188:drug therapy* / Q000503:physiopathology; D006074:Gout Suppressants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010146:Pain / Q000188:drug therapy
D006074:Gout Suppressants; D003078:Colchicine