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We wish to comment on the recent Medsafe Prescriber Update regarding colchicine (Colchicine: Beware of toxicity and interaction, March 2011). We acknowledge the importance of careful dosing of colchicine for acute gout, as outlined in the New Zealand Rheumatology Association position statement on the use of colchicine.1 However, this agent (used at appropriate doses) remains a very important drug for management of acute gout in Aotearoa New Zealand.This is particularly the case for patients with co-morbidities such as diabetes, renal impairment and peptic ulcer disease, where alternatives such as non steroidal anti-inflammatory drugs and prednisone may cause significant toxicity. Colchicine at low dose has been shown to be effective and safe in a recent clinical trial of acute gout.2 We also note that a recent study of colchicine prescribing in South Auckland has shown that excessive colchicine dosing is extremely uncommon.3 We are concerned that the recommendation that ccolchicine....must be used with extreme cared is excessively alarmist, and may discourage practitioners from prescribing this very useful drug for acute gout.Low dose colchicine also has a central role in gout prophylaxis; to prevent flares of gout when patients start urate-lowering therapy such as allopurinol. The use of low dose daily colchicine prophylaxis for at least three months following initiation of allopurinol is supported by clinical trial data and is endorsed by the European League Against Rheumatism and the British Society for Rheumatology.4-6 Numerous studies in Aotearoa New Zealand have shown that allopurinol is under-prescribed in patients with gout, leading to ongoing poor disease control and risk of joint damage and disability.7-9 A major reason for this is the exacerbation of gout flares that occur when starting allopurinol. These flares are significantly reduced by co-prescription with low dose colchicine.4,10Therefore, we are concerned that the Medsafe Prescriber Update will discourage use of low dose colchicine for gout prophylaxis, which in turn will lead to lower uptake of allopurinol, with the attendant consequences of work absences, increased health disparity, joint damage, renal impairment and increased risk of cardiovascular disease and premature death. Associate Professor Nicola Dalbeth Consultant Rheumatologist Associate Professor Peter Gow Consultant Rheumatologist and Clinical Head Counties Manukau District Health Board, Auckland. On behalf of the New Zealand Rheumatology Association.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Associate Professor Nicola Dalbeth, Consultant Rheumatologist, Associate Professor Peter Gow, Consultant Rheumatologist and Clinical Head, Counties Manukau District Health Board, Auckland. On behalf of the New Zealand Rheumatology Association.

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

NZRA. NZRA consensus statement on the use of colchicine in the treatment of gout. 2010 [cited; Available from:http://www.rheumatology.org.nz/position_statement.cfmTerkeltaub RA, Furst DE, Bennett K, et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060-8.Ly J, Gow P, Dalbeth N. Colchicine prescribing and safety monitoring in patients with gout. N Z Med J. 2007;120(1265):U2808.Borstad GC, Bryant LR, Abel MP,et al. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol. 2004;31(12):2429-32.Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1312-24.Jordan KM, Cameron JS, Snaith M, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford). 2007;46(8):1372-4.Dalbeth N, Kumar S, Stamp L, Gow P. Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. J Rheumatol. 2006;33(8):1646-50.Hutton I, Gamble G, Gow P, Dalbeth N. Factors associated with recurrent hospital admissions for gout: a case-control study. J Clin Rheumatol. 2009;15(6):271-4.Suppiah R, Dissanayake A, Dalbeth N. High prevalence of gout in patients with Type 2 diabetes: male sex, renal impairment, and diuretic use are major risk factors. N Z Med J. 2008;121(1283):43-50.Wortmann RL, Macdonald PA, Hunt B, Jackson RL. Effect of Prophylaxis on Gout Flares After the Initiation of Urate-Lowering Therapy: Analysis of Data From Three Phase III Trials. Clin Ther. 2010;32(14):2386-97.

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We wish to comment on the recent Medsafe Prescriber Update regarding colchicine (Colchicine: Beware of toxicity and interaction, March 2011). We acknowledge the importance of careful dosing of colchicine for acute gout, as outlined in the New Zealand Rheumatology Association position statement on the use of colchicine.1 However, this agent (used at appropriate doses) remains a very important drug for management of acute gout in Aotearoa New Zealand.This is particularly the case for patients with co-morbidities such as diabetes, renal impairment and peptic ulcer disease, where alternatives such as non steroidal anti-inflammatory drugs and prednisone may cause significant toxicity. Colchicine at low dose has been shown to be effective and safe in a recent clinical trial of acute gout.2 We also note that a recent study of colchicine prescribing in South Auckland has shown that excessive colchicine dosing is extremely uncommon.3 We are concerned that the recommendation that ccolchicine....must be used with extreme cared is excessively alarmist, and may discourage practitioners from prescribing this very useful drug for acute gout.Low dose colchicine also has a central role in gout prophylaxis; to prevent flares of gout when patients start urate-lowering therapy such as allopurinol. The use of low dose daily colchicine prophylaxis for at least three months following initiation of allopurinol is supported by clinical trial data and is endorsed by the European League Against Rheumatism and the British Society for Rheumatology.4-6 Numerous studies in Aotearoa New Zealand have shown that allopurinol is under-prescribed in patients with gout, leading to ongoing poor disease control and risk of joint damage and disability.7-9 A major reason for this is the exacerbation of gout flares that occur when starting allopurinol. These flares are significantly reduced by co-prescription with low dose colchicine.4,10Therefore, we are concerned that the Medsafe Prescriber Update will discourage use of low dose colchicine for gout prophylaxis, which in turn will lead to lower uptake of allopurinol, with the attendant consequences of work absences, increased health disparity, joint damage, renal impairment and increased risk of cardiovascular disease and premature death. Associate Professor Nicola Dalbeth Consultant Rheumatologist Associate Professor Peter Gow Consultant Rheumatologist and Clinical Head Counties Manukau District Health Board, Auckland. On behalf of the New Zealand Rheumatology Association.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Associate Professor Nicola Dalbeth, Consultant Rheumatologist, Associate Professor Peter Gow, Consultant Rheumatologist and Clinical Head, Counties Manukau District Health Board, Auckland. On behalf of the New Zealand Rheumatology Association.

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

NZRA. NZRA consensus statement on the use of colchicine in the treatment of gout. 2010 [cited; Available from:http://www.rheumatology.org.nz/position_statement.cfmTerkeltaub RA, Furst DE, Bennett K, et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060-8.Ly J, Gow P, Dalbeth N. Colchicine prescribing and safety monitoring in patients with gout. N Z Med J. 2007;120(1265):U2808.Borstad GC, Bryant LR, Abel MP,et al. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol. 2004;31(12):2429-32.Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1312-24.Jordan KM, Cameron JS, Snaith M, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford). 2007;46(8):1372-4.Dalbeth N, Kumar S, Stamp L, Gow P. Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. J Rheumatol. 2006;33(8):1646-50.Hutton I, Gamble G, Gow P, Dalbeth N. Factors associated with recurrent hospital admissions for gout: a case-control study. J Clin Rheumatol. 2009;15(6):271-4.Suppiah R, Dissanayake A, Dalbeth N. High prevalence of gout in patients with Type 2 diabetes: male sex, renal impairment, and diuretic use are major risk factors. N Z Med J. 2008;121(1283):43-50.Wortmann RL, Macdonald PA, Hunt B, Jackson RL. Effect of Prophylaxis on Gout Flares After the Initiation of Urate-Lowering Therapy: Analysis of Data From Three Phase III Trials. Clin Ther. 2010;32(14):2386-97.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

We wish to comment on the recent Medsafe Prescriber Update regarding colchicine (Colchicine: Beware of toxicity and interaction, March 2011). We acknowledge the importance of careful dosing of colchicine for acute gout, as outlined in the New Zealand Rheumatology Association position statement on the use of colchicine.1 However, this agent (used at appropriate doses) remains a very important drug for management of acute gout in Aotearoa New Zealand.This is particularly the case for patients with co-morbidities such as diabetes, renal impairment and peptic ulcer disease, where alternatives such as non steroidal anti-inflammatory drugs and prednisone may cause significant toxicity. Colchicine at low dose has been shown to be effective and safe in a recent clinical trial of acute gout.2 We also note that a recent study of colchicine prescribing in South Auckland has shown that excessive colchicine dosing is extremely uncommon.3 We are concerned that the recommendation that ccolchicine....must be used with extreme cared is excessively alarmist, and may discourage practitioners from prescribing this very useful drug for acute gout.Low dose colchicine also has a central role in gout prophylaxis; to prevent flares of gout when patients start urate-lowering therapy such as allopurinol. The use of low dose daily colchicine prophylaxis for at least three months following initiation of allopurinol is supported by clinical trial data and is endorsed by the European League Against Rheumatism and the British Society for Rheumatology.4-6 Numerous studies in Aotearoa New Zealand have shown that allopurinol is under-prescribed in patients with gout, leading to ongoing poor disease control and risk of joint damage and disability.7-9 A major reason for this is the exacerbation of gout flares that occur when starting allopurinol. These flares are significantly reduced by co-prescription with low dose colchicine.4,10Therefore, we are concerned that the Medsafe Prescriber Update will discourage use of low dose colchicine for gout prophylaxis, which in turn will lead to lower uptake of allopurinol, with the attendant consequences of work absences, increased health disparity, joint damage, renal impairment and increased risk of cardiovascular disease and premature death. Associate Professor Nicola Dalbeth Consultant Rheumatologist Associate Professor Peter Gow Consultant Rheumatologist and Clinical Head Counties Manukau District Health Board, Auckland. On behalf of the New Zealand Rheumatology Association.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Associate Professor Nicola Dalbeth, Consultant Rheumatologist, Associate Professor Peter Gow, Consultant Rheumatologist and Clinical Head, Counties Manukau District Health Board, Auckland. On behalf of the New Zealand Rheumatology Association.

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

NZRA. NZRA consensus statement on the use of colchicine in the treatment of gout. 2010 [cited; Available from:http://www.rheumatology.org.nz/position_statement.cfmTerkeltaub RA, Furst DE, Bennett K, et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62(4):1060-8.Ly J, Gow P, Dalbeth N. Colchicine prescribing and safety monitoring in patients with gout. N Z Med J. 2007;120(1265):U2808.Borstad GC, Bryant LR, Abel MP,et al. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol. 2004;31(12):2429-32.Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65(10):1312-24.Jordan KM, Cameron JS, Snaith M, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford). 2007;46(8):1372-4.Dalbeth N, Kumar S, Stamp L, Gow P. Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. J Rheumatol. 2006;33(8):1646-50.Hutton I, Gamble G, Gow P, Dalbeth N. Factors associated with recurrent hospital admissions for gout: a case-control study. J Clin Rheumatol. 2009;15(6):271-4.Suppiah R, Dissanayake A, Dalbeth N. High prevalence of gout in patients with Type 2 diabetes: male sex, renal impairment, and diuretic use are major risk factors. N Z Med J. 2008;121(1283):43-50.Wortmann RL, Macdonald PA, Hunt B, Jackson RL. Effect of Prophylaxis on Gout Flares After the Initiation of Urate-Lowering Therapy: Analysis of Data From Three Phase III Trials. Clin Ther. 2010;32(14):2386-97.

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