Colchicine prescribing and safety monitoring in patients with gout.

AIM: To assess current colchicine prescribing and safety monitoring in patients with gout.
METHODS: Colchicine dosing was analysed by chart review of 50 consecutive patients presenting to Middlemore Hospital (South Auckland, New Zealand) with acute gout. The dose of colchicine was compared with the New Zealand Rheumatology Association (NZRA) consensus statement on colchicine use for acute gout. Safety monitoring was analysed by chart review of a separate group of 50 patients attending rheumatology clinics on long-term prophylactic colchicine and with renal impairment (creatinine > or = 0.17 mmol/L or creatinine clearance < or =0.83 ml/sec). Monitoring of creatine kinase (CK) and full blood count (FBC) was compared with published quality of care indicators regarding safety monitoring of colchicine. Risk factors for colchicine toxicity were recorded; age >75 years, statin use, renal transplant, haemodialysis, and renal impairment.
RESULTS: Forty-eight (96%) patients treated for acute gout received colchicine at doses < or =2.5 mg/24 hours, in accordance with the NZRA statement. In this group, 60% had at least one risk factor for colchicine toxicity. For the long-term prophylactic colchicine treatment group, 76% had CK and FBC monitoring in accordance with the quality of care indicator. Additional risk factors for colchicine toxicity were present in 58% of patients on long-term colchicine. Laboratory monitoring identified colchicine-related adverse drug reaction in one patient.
CONCLUSIONS: Current prescribing of colchicine for acute gout is in accordance with the NZRA consensus statement. For long-term colchicine use, there is reasonable adherence to the quality of care indicator for safety monitoring. These patients are at high risk for toxicity, and safety monitoring has an acceptable yield.