Lecrosnier Aude (1), Barat Eric Pharm. D (2), Ottaviani Sébastien Md (3), Rat Anne-Christine Md, Phd (4), Grosjean Julien Phd (5,6), Weber Anne-Joëlle Md (7), Guerrot Dominique Md, Phd (8), Lequerré Thierry Md, Phd(1), Vittecoq Olivier Md, Phd (1), Gérard Baptiste Md (1,9*)
Affiliation(s):
1. Department Of Rheumatology & Cic-crb 1404, Rouen University Hospital, Rouen, France
2. Department Of Pharmacy, Rouen University Hospital, Rouen, France
3. Department Of Rheumatology, Bichat Hospital, Ap-hp, Paris, France
4. Department Of Rheumatology, Caen University Hospital, Caen, France
5. Department Of Biomedical Informatics, Rouen University Hospital, Rouen, France
6. Limics, Inserm U1142, Sorbonne University & Sorbonne Paris Nord University
7. Department Of Rheumatology, Evreux Hospital, Evreux, France
8. Department Of Nephrology & Cic-crb 1404, Rouen University Hospital, Rouen, France
9. Ea 7446 - Ethics, Lille, France
Background: Colchicine is a pivotal treatment recommended for management of crystal-induced arthritis flares (gout and calcium pyrophosphate deposition [CPPD] disease), but comorbidities associated with these conditions could lead to difficulties in the use of this treatment. Chronic kidney disease (CKD) is regularly associated with these conditions [1], with a five-fold increase in the prevalence of gout in patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min per 1.73 m2 when compared with patients without kidney disease [2]. As colchicine is excreted by the kidneys and minimally removed by dialysis, treating acute flares in patients with CKD can be challenging. Nevertheless, colchicine is commonly used in clinical practice in patients with severe CKD (eGFR <30 mL/min per 1.73 m2), with potential toxicity enhanced.
Objectives: To analyze prescription of colchicine and its efficacy and safety in management of crystal-induced arthritis flares in patients with severe CKD.
Methods: All crystal-induced arthritis flares (gout or CPPD disease) treated by colchicine in hospitalized patients with severe CKD or on dialysis in four French centers were screened from January 2015 to December 2023. Data were collected retrospectively from medical records. Treatment efficacy was assessed by composite criterion including clinical improvement estimated by the medical team with decrease in C-reactive protein level as compared with the level prior to starting treatment.
Results: Out of 159 hospitalizations, 157 patients (101 men; median age: 80 years; IQR 71-88) with colchicine prescriptions were screened. Among them, the prescriptions concerned 141 cases of gout flares and 18 cases of CPPD disease arthritis. The median eGFR was 23 mL/min per 1.73 m2 (IQR 18-25), with 133 patients with stage 4 CKD and 26 patients with stage 5 CKD, including 21 on dialysis and 13 which had undergone kidney transplantation. The main reason of hospitalization was joint pain (24%), heart failure (18%) and fall (8%). Initial colchicine dosage was 0.5 mg/day in 86 cases (54%) with no dosage exceeding 1 mg/day except for one patient who received 1.5 mg per day. The median duration of treatment was ten days (IQR 7-14). Colchicine was considered effective in 145 cases (91%), without dosage adaptation in most situations. Concerning tolerance, three cases of acute renal function deterioration, one colchicine-induced hepatitis and three overdosages of vitamin K antagonist without bleeding complications were reported.
Conclusion: This real-life study concerning use of colchicine for crystal-induced arthritis flare in patients with severe CKD provides reassuring data. Considering dose reduction, colchicine could be used in these conditions with caution and close monitoring.
References:
1. Kleiber Balderrama C, Rosenthal AK, Lans D, et al. Calcium Pyrophosphate Deposition Disease and Associated Medical Comorbidities: A National Cross-Sectional Study of US Veterans. Arthritis Care Res (Hoboken). 2017;69:1400–6. doi: 10.1002/acr.23160
2. Krishnan E. Reduced glomerular function and prevalence of gout: NHANES 2009-10. PLoS One. 2012;7:e50046. doi: 10.1371/journal.pone.0050046