ODSR: Comparison of colchicine in the treatment of acute gout.

Background: Gout is a very common cause of inflammatory arthritis (pain, redness, heat, and swelling of the affected joints) .
It is caused by the formation of urate crystals in or around the joints
.

Uric acid is a waste product normally produced in the body, usually excreted in urine

The cause of inflammatory arthritis (pain, redness, heat, and swelling of the affected joints) is caused by the formation of urate crystals in or around the joints

Search method: We have updated the search of CENTER, MEDLINE, EMBASE, ClinicalTrials.
gov and the WHO ICTRP registry to August 28, 2020
.

We did not impose any date or language restrictions in the search

Selection criteria: We considered published randomized controlled trials (RCT) and quasi-randomized controlled trials (quasi-RCT) to evaluate the efficacy of colchicine treatment and other treatments (placebo or other effective treatment methods) in acute gout, low The clinically relevant dose comparison of colchicine and placebo is the main comparison
.

The main results are pain, participants' overall assessment of treatment success (50% or more reduction in pain from baseline to 32 hours to 36 hours), reduction in inflammation, related joint function, serious adverse events, total adverse events, and adverse events due to And stop the drug

Data collection and analysis: We used standard methodological procedures expected by Cochrane to collect data
.

Main results: In this latest review, we included four trials (803 random participants), including two new trials
.

A three-group trial compared high-dose colchicine (52 participants), low-dose colchicine (74 participants) and placebo (59 participants); one trial compared high-dose colchicine with Placebo was compared (43 participants); one trial compared low-dose colchicine with non-steroidal anti-inflammatory drugs (NSAIDs) (399 participants); and one trial compared low-dose colchicine Alkali was compared with Chuanhu anti-gout mixture (Chinese medicine compound) (176 participants)

The average age of the participants ranged from 51.
2 to 70 years, and the duration of the trial ranged from 48 hours to 12 weeks
.

Two trials have a low risk of bias, one trial may be susceptible to selection bias (random sequence generation), reporting bias, and other biases, while the other open-label trial has a higher risk of performance and detection bias

For preliminary comparison, low quality evidence from one trial (103 participants, due to the inaccuracy and bias was demoted) showed that compared with placebo, low-dose colchicine may improve treatment outcome , risk of adverse events Little or no increase
.

The number of people who reported successful treatment (50% or more pain relief) within 32 to 36 hours, and the number of people who used low-dose colchicine (418/1000) was slightly higher than that of placebo (172/1000; risk ratio (RR) 2.

Compared with placebo, low-dose colchicine may improve treatment outcomes .

Compared with placebo, large doses of colchicine may improve symptoms, but increase the risk of harm

More adverse events associated with higher doses

Since few serious adverse events were reported in the trial, we cannot estimate the risk of serious adverse events in most comparisons
.

One trial (399 participants) reported three serious adverse reactions (one participant who received low-dose colchicine and two participants who received non-steroidal anti-inflammatory drugs) for reasons not related to the trial (low quality The evidence is downgraded due to bias and imprecision)
.

Table 1 Low-dose colchicine and placebo in the treatment of acute gout

Table 1 Low-dose colchicine and placebo in the treatment of acute gout

Table 2 High-dose colchicine and placebo in the treatment of acute gout

Table 2 High-dose colchicine and placebo in the treatment of acute gout

Table 3 Comparison of the effects of high-dose colchicine and low-dose colchicine on acute gout

Table 3 Comparison of the effects of high-dose colchicine and low-dose colchicine on acute gout

Table 4 Comparison of efficacy of low-dose colchicine and non-steroidal anti-inflammatory drugs

Table 4 Comparison of efficacy of low-dose colchicine and non-steroidal anti-inflammatory drugs

Conclusion: We found that compared with placebo, low-quality evidence suggests that low-dose colchicine may be an effective treatment for acute gout, and its benefits may be similar to non-steroidal anti-inflammatory drugs
.
We reduce the bias and imprecision of the evidence
.
Compared with placebo, high dose and low-dose colchicine can improve pain, low quality evidence suggests that compared with placebo, high dose (rather than low doses) colchicine may increase the number of adverse events, and low Quality evidence suggests that the number of adverse events may be similar in low-dose colchicine and NSAIDs
.
At present, there are no trials to report the effect of colchicine on people with comorbidities, or compare it with other commonly used treatment methods such as glucocorticoids
.

Low-dose colchicine may be an effective treatment for acute gout, and its benefits may be similar to non-steroidal anti-inflammatory drugs
.
Both high-dose and low-dose colchicine can improve pain.
Compared with placebo, high-dose (rather than low-dose) colchicine may increase the number of adverse events.
The number of adverse events may be in low-dose colchicine and NSAIDs Similar
.

Original source:

 McKenzie BJ, Wechalekar MD, Johnston RV,et al.
Colchicine for acute gout.
Ochrane Database Syst Rev 2021 Aug 26;8

Colchicine for acute gout.
Leave a message here