Safety of colchicine and NSAID prophylaxis when initiating urate-lowering therapy for gout: propensity score-matched cohort studies in the UK Clinical Practice Research Datalink
Two retrospective studies found adverse events were more common in those prescribed colchicine prophylaxis (particularly diarrhoea; HR 2.22;95%CI 1.83 to 2.69) or NSAID prophylaxis (e.g.acute kidney injury;1.56;95% CI 1.20 to 2.03) than in those not taking any flare prophylaxis.
Source:
Annals of Rheumatic Diseases
SPS commentary:
The researchers say their findings can inform treatment decisions and the choice between colchicine or NSAIDs for prophylaxis. They note that although adverse events were more common in people who initiated allopurinol with flare prophylaxis than those initiating without, serious adverse events were uncommon, which provides some reassurance. Future research is needed to determine which patients are at greatest risk of adverse events from prophylaxis and whether the cardiovascular benefits of colchicine reported in RCTs of people at high risk of cardiovascular events because of a prior history of coronary heart disease also apply to people with gout.