Background The rising cost of colchicine in the United States for the treatment of gout resulted in our evaluation of the use of colchicine in the management of gout.
Objectives The purpose of this analysis was to ascertain whether colchicine is used appropriately and if we could reduce the cost of colchicine use at the VA Connecticut Healthcare System (VACHCS) by establishing criteria for its use.
Methods All VACHCS primary care patients who were currently taking colchicine in July 2011 were identified using the pharmacy prescription processing system (VISTA). A total of 515 patients were identified from VISTA as being on colchicine. Patients who were on short courses of colchicine (prescriptions given for less than 30 days) or for whom it was prescribed on a PRN basis were excluded. We identified situations in which we felt the use of chronic colchicine was inappropriate: 1. colchicine use for > 6 months with control of clinical gout; 2. chronic colchicine alone without hypouricemic therapy; 3. serum uric acid levels > 6 mg/dl without control of gout and no attempt to titrate hypouricemic agent; 4. serum uric acid level not checked in the past 6 months
Results Of the 515 patients identified as taking colchicine, 41 patients were prescribed colchicine for less than 30 days and 263 patients were on colchicine on a PRN basis. The remaining 211 patients charts were reviewed and they formed the study group. All these patients were on colchicine inappropriately fulfilling one or more of the above criteria. A total of 168 (79%) had serum uric acid levels checked within a year. Of these patients only 56(26%) were below the recommended serum uric acid target level of 6 mg/dl or less. 113(54%) patients were on hypouricemic drugs (allopurinol/febuxastat or probenecid). The average dose of allopurinol was only 225mg. Those patients on hypouricemic drugs, only 45 had serum uric acid levels at or below target.
Conclusions Our study demonstrates that a significant percentage of gout patients are inappropriately on long-term colchicine with only 26% having serum uric acid levels at or below the target level of 6 mg/dl. In addition, a number of patients were either on sub-therapeutic doses or on no hypouricemic agents at all. Following guidelines for appropriate colchicine use will not only reduce the cost of colchicine use but also decrease the risk of adverse events.
References Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis Borstad GC, Alloway A randomised controlled trial on the efficacy and tolerability with dose escalation of allopurinol 300-600mg/day versus benzbromarone 100-200mg/day in patients with gout. Reinders MK, Brouwers JR. A critical reappraisal of allopurinol dosing, safety and efficacy for hypouricemia in gout. Chao J, Terkeltaub R.Oral colchicine (Colcrys): in the treatment and prophylaxis of gout. Yang LP
Disclosure of Interest None Declared