Oral colchicine (Colcrys): in the treatment and prophylaxis of gout

Oral colchicine (Colcrys) is approved in the US for the treatment of acute gout flares in adult patients and the prophylaxis of gout flares in patients aged >16 years. Colchicine is a tricyclic alkaloid that interrupts multiple inflammatory response pathways. Its principal mechanism of action in gout is thought to be inhibition of cytoskeletal microtubule polymerization, an important process in neutrophil functioning. In a phase III, randomized, double-blind, placebo-controlled, multicentre trial, the recommended dosage of Colcrys (1.2 mg at the first sign of the flare, followed by 0.6 mg in 1 hour) was significantly more effective than placebo in treating acute gout flare, as assessed by the proportion of patients experiencing a >or=50% reduction in pain within 24 hours of initiating treatment. In a randomized, double-blind, placebo-controlled, single-centre trial, non-approved colchicine 0.6 mg once or twice daily (up to 6 months) was more effective than placebo in preventing gout flares in patients receiving allopurinol as urate-lowering therapy. At the recommended dosage for the treatment of acute gout flares, Colcrys was as well tolerated as placebo in patients with gout. The incidence of the most common adverse events was similar between recipients of the recommended dosage of Colcrys and placebo.