통풍 환자에서 요산 저하제 사용 중 콜히친 예방, Colchicine prophylaxis in the course of Tx with uricosuric agents

경구 colchicine은 요산저하제 치료 초기에 재발성 통풍 발작의 빈도를 줄일 수 있습니다. 매일 0.6 mg 하루 1회~2회 투약하며 고령에서는 설사와 같은 부작용이 있을 수 있는데 이러한 경우는 하루 1회에서 2일에 1회로 감량합니다. Colchicine은 Ccr가 10미만이거나 투석 중인 환자에서는 사용해서는 안됩니다.

Oral colchicine can reduce the frequency of recurrent gout flares early in the course of urate lowering with uricosuric agents or xanthine oxidase inhibitors (XOIs). A typical colchicine regimen at the initiation of urate-lowering therapy is 0.6 mg orally once or twice daily for patients with normal renal function. Many patients, particularly older individuals, develop loose or diarrheal stools that preclude use of the recommended colchicine dose. Satisfactory prophylaxis in such patients is often attained with the lower colchicine doses of 0.6 mg once daily or even every other day. The dose of colchicine should also be reduced to 0.6 mg per day in patients with a creatinine clearance of 35 to 49 mL/minute and to 0.6 mg every two to three days in patients with a creatinine clearance of 10 to 34 mL/minute. Colchicine should not be used in patients with a creatinine clearance <10 mL/minute or in patients undergoing dialysis for end-stage renal disease.

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Tophi가 없는 환자에서 colchicine은 일반적으로 요산 수치가 목표에 도달한 이후 3-6개월 동안 지속합니다. 그 이상 사용하지 않는데 잠정적 독성과 요산 결정 침착을 막아주지 못하기 때문입니다.

In patients without tophi, colchicine is generally continued for three to six months after achievement of the goal urate level to prevent gout flares during the initiation of urate-lowering therapy because it is potentially toxic (eg, myopathy or neuromyopathy) and does not prevent urate crystal accumulation. It is thus infrequently used for long-term prophylaxis, compared with the usual long-term use of uricosuric drugs and XOIs.

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Colchicine 유발 신경근육병은 만성 치료의 잠재적 합병증입니다.

Colchicine-induced neuromyopathy is a potential complication of chronic therapy, particularly in patients with a reduced creatinine clearance. It should be suspected in patients who complain of paresthesias, numbness, and/or weakness. Most cases occur in patients treated with daily low-dose colchicine for months to years. Patients taking HMG-CoA reductase inhibitors (statins) may be at increased risk for colchicine-induced myopathy. Organ transplant recipients who develop gout and are treated with colchicine while receiving cyclosporine are at increased risk for colchicine myopathy. Such patients should be treated, if at all, with low doses of colchicine and for as brief a period of time as possible.

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요산저하제를 시작하는 환자에서 예방적 colchicine 사용의 효능은 43명의 환자를 무작위 할당한 임상시험에서 입증되었습니다.

The efficacy of prophylactic colchicine in patients beginning urate-lowering therapy was demonstrated in a randomized trial in which 43 patients were assigned to treatment with colchicine or placebo prior to initiation of urate-lowering therapy. The patients were then followed for at least three months beyond the time their serum urate levels were reduced to a level of less than 6.5 mg/dL (<387 micromol/L). At six months, there were significantly fewer gout flares in those who received colchicine (mean number of flares 0.1 versus 1.8 with placebo).

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REF. UPTODATE 2019.02.20