Ann Rheum Dis

Is colchicine prophylaxis required with start-low go-slow allopurinol dose escalation in gout?

December 18, 2023

Among adults with at least one gout flare in the preceding 6 months who fulfilled ACR recommendations for starting urate-lowering therapy, a 6-month period with low-dose colchicine during ‘start-low go-slow’ allopurinol initiation suppressed gout flares; whereas placebo failed to meet the prespecified non-inferiority margin compared with colchicine. 

• 200 adults with at least one gout flare in the preceding six months were included and randomized 1:1 to colchicine 0.5 mg daily or placebo for the first six months.
• Primary efficacy outcome was the mean number of gout flares per month in the first six months with a prespecified non-inferiority margin of 0.12 gout flares/month.
• The mean (95% confidence interval [CI]) number of gout flares/month between baseline and month six was 0.61 (0.47 to 0.74) in the placebo group compared with 0.35 (0.22 to 0.49) in the colchicine group, mean difference 0.25 (0.07 to 0.44), non-inferiority p=0.92. There was no difference in the mean number of gout flares/month between randomized groups over the 12-month period (p=0.68).
• There were 11 serious adverse events among seven colchicine recipients and three events among 2 placebo recipients.

Source:

Stamp L, et al. (2023, December). Ann Rheum Dis. Is colchicine prophylaxis required with start-low go-slow allopurinol dose escalation in gout? A non-inferiority randomised double-blind placebo-controlled trial. https://pubmed.ncbi.nlm.nih.gov/37652661/