medwireNews: Taking colchicine prophylaxis at the time of initiating urate-lowering therapy for gout flare could reduce the risk for cardiovascular events, suggests an observational study.
The findings showed that patients taking colchicine for at least 21 days at the same time as starting urate-lowering therapy were a significant 18% less likely than those not receiving any prophylaxis to experience fatal or nonfatal myocardial infarction or stroke within 180 days of gout flare.
“Colchicine might reduce cardiovascular risk in patients with gout initiating urate-lowering therapy by both limiting vascular inflammation and preventing flares,” say the investigators in The Lancet Rheumatology, adding that “prescribing gout flare prophylaxis with colchicine might lead to better overall outcomes for patients with gout by both preventing gout flares and cardiovascular events.”
In a related comment, Hein Janssens (Radboud University Medical Centre, Nijmegen, the Netherlands) and Matthijs Janssen (VieCuri Medical Centre, Venlo, the Netherlands) remark that “observing cardiovascular benefits as side-effects of a drug regime within 6 months, which is recommended in most management guidelines for gout, is rather exciting.”
They urge for “the findings in this robust, high-quality observational study be the invitation for gout researchers to design a randomised controlled trial to confirm them.”
Edoardo Cipolletta (University of Nottingham, UK) and colleagues studied data on 111,460 patients newly diagnosed with gout from the Clinical Practice Research Datalink Aurum, an English primary care database of hospitalization and mortality records.
Of these individuals, 99,800 initiated urate-lowering therapy for the first time and 16,028 (16.1%) were also prescribed colchicine prophylaxis, at a mean daily dose of 0.97 mg (0.5–1.0 mg) for an average duration of about 50 days. The participants were aged a mean of 62.8 years, 74.4% were men, and 85.1% were White.
The mean disease duration was 2.4 years in the patients receiving colchicine and 1.7 years in those not receiving prophylaxis, and the mean serum urate levels at baseline were a comparable 384 µmol/L and 389 µmol/L, respectively. These decreased by an average 135.2 µmol/L and 130.3 µmol/L over the mean 175.5 and 176.9 days of follow-up, respectively.
The primary endpoint of fatal or nonfatal myocardial infarction or stroke occurred in 1.4% of patients taking colchicine versus 1.7% of those not taking prophylaxis in the intention-to-treat analysis.
This translated to respective incidence rates of 28.8 and 35.3 per 1000 person–years, when the two groups were matched for age, chronic kidney disease, presence of trophi, other cardiovascular risk factors, and level of gout care and medication, giving a significant reduction of 6.5 events per 1000 person–years with colchicine prophylaxis.
The weighted number needed to treat with colchicine prophylaxis to prevent one cardiovascular event was 154, the team reports.
The researchers note that the benefit of colchicine was consistent irrespective of whether people had a history of cardiovascular disease and was also demonstrated in a per-protocol analysis. The secondary endpoint of first-ever cardiovascular event was significantly reduced by 20% with colchicine prophylaxis versus no prophylaxis. However, there was no significant difference in the rate of fatal cardiovascular events.
Commentators Janssens and Janssen say that “it is conceivable that, if a cardiovascular risk reduction is indeed confirmed, a strong argument arises to recommend the prescription of a course of colchicine to all (flaring) patients with gout, independently of their preference for urate-lowering therapy in general or urate-lowering therapy with or without colchicine prophylaxis more specifically.”
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Lancet Rheumatol 2024; doi:10.1016/S2665-9913(24)00248-0
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