Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;82(12):1618-1625.
doi: 10.1136/ard-2023-224154. Epub 2023 Oct 3.

Safety of colchicine and NSAID prophylaxis when initiating urate-lowering therapy for gout: propensity score-matched cohort studies in the UK Clinical Practice Research Datalink

Edward Roddy  1   2 , Ram Bajpai  3 , Harry Forrester  3 , Richard James Partington  3 , Christian D Mallen  3 , Lorna Elise Clarson  3 , Nishita Padmanabhan  3 , Rebecca Whittle  3 , Sara Muller  3
Affiliations

Safety of colchicine and NSAID prophylaxis when initiating urate-lowering therapy for gout: propensity score-matched cohort studies in the UK Clinical Practice Research Datalink

Edward Roddy et al. Ann Rheum Dis. 2023 Dec.

Abstract

Objectives: To determine the risk of adverse events associated with colchicine or non-steroidal anti-inflammatory drug (NSAID) prophylaxis when initiating allopurinol for gout.

Methods: We conducted two matched retrospective cohort studies in linked UK Clinical Practice Research Datalink and Hospital Episode Statistics datasets. Adults initiating allopurinol for gout with (1) colchicine or (2) NSAID prophylaxis were compared with those initiating without prophylaxis, individually matched by age, sex and propensity to receive the relevant prophylaxis. Weighted Cox proportional hazards models investigated associations between colchicine/NSAID and specified adverse events.

Results: 13 945 individuals prescribed colchicine were matched to 13 945 with no prophylaxis and 25 980 prescribed NSAID to 25 980 with no prophylaxis. Adverse event incidence rates were <200/10 000 patient-years except diarrhoea (784.4; 95% CI 694.0 to 886.5) and nausea (208.1; 95% CI 165.4 to 261.7) for colchicine and angina for NSAID (466.6; 95% CI 417.2 to 521.8). Diarrhoea (HR 2.22; 95% CI 1.83 to 2.69), myocardial infarction (MI) (1.55; 95% CI 1.10, 2.17), neuropathy (4.75; 95% CI 1.20 to 18.76), myalgia (2.64; 95% CI 1.45 to 4.81), bone marrow suppression (3.29; 95% CI 1.43 to 7.58) and any adverse event (1.91, 95% CI 1.65 to 2.20) were more common with colchicine than no prophylaxis, but not nausea/vomiting (1.34; 95% CI 0.97 to 1.85). Angina (1.60; 95% CI 1.37 to 1.86), acute kidney injury (1.56; 95% CI 1.20 to 2.03), MI (1.89; 95% CI 1.44 to 2.48), peptic ulcer disease (1.67; 95% CI 1.14 to 2.44) and any adverse event (1.63; 95% CI 1.44 to 1.85) were more common with NSAID than without.

Conclusions: Adverse events were more common when allopurinol was initiated with prophylaxis, particularly diarrhoea with colchicine. Other events were uncommon, providing reassurance for patients and clinicians to enable shared decision-making.

Keywords: Anti-Inflammatory Agents, Non-Steroidal; Epidemiology; Gout.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Kuo C-F, Grainge MJ, Mallen C, et al. . Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis 2015;74:661–7. 10.1136/annrheumdis-2013-204463 - DOI - PMC - PubMed
    1. Bevis M, Blagojevic-Bucknall M, Mallen C, et al. . Comorbidity clusters in people with gout: an observational cohort study with linked medical record review. Rheumatology (Oxford) 2018;57:1358–63. 10.1093/rheumatology/key096 - DOI - PubMed
    1. Watson L, Belcher J, Nicholls E, et al. . Factors associated with change in health-related quality of life in people with gout: a three-year prospective cohort study in primary care. Rheumatology (Oxford) 2023;62:2748–56. 10.1093/rheumatology/keac706 - DOI - PMC - PubMed
    1. Richette P, Doherty M, Pascual E, et al. . Updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017;76:29–42. 10.1136/annrheumdis-2016-209707 - DOI - PubMed
    1. Hui M, Carr A, Cameron S, et al. . British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford) 2017;56:1056–9. 10.1093/rheumatology/kex156 - DOI - PubMed

Publication types