The quality of evidence is downgraded by study limitations (risk of selection bias from unclear reporting of the method of randomisation, and risk of reporting bias), and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 4 studies with a total of 803 subjects Treatments consisted of high-dose colchicine (1 mg followed by 0.5 mg every 2 hours until complete response or adverse events) versus placebo (total dose not specified), high-dose colchicine (4.8 mg over 6 hours) versus placebo, low-dose colchicine (1.8 mg over 1 hour) versus placebo, high-dose colchicine versus low-dose colchicine, low-dose colchicine (0.5 mg 3 times per day for 4 days) versus NSAIDs (750 mg of naproxen at baseline then 250 mg every 8 hours for 7 days), or low-dose colchicine (0.5 mg twice daily for 3 days, then 0.5 mg daily for 7 days) versus Chuanhu anti-gout mixture (250 mL).
A greater proportion of people receiving low-dose colchicine experienced a 50% or greater decrease in pain at 32 to 36 hours compared with placebo (418 per 1000 vs. 72 per 1000; RR 2.43, 95% CI 1.05 to 5.64; NNTB 5; 1 study, n=103) with little or no increase in risk of adverse events (364 per 1000 with low-dose colchicine compared with 276 per 1000 with placebo; RR 1.32, 95% CI 0.68 to 2.56). No participants withdrew due to adverse events or reported any serious adverse events.
More participants reported treatment success at 32 to 36 hours with high-dose colchicine compared to placebo (518 per 1000 vs. 240 per 1000; RR 2.16, 95% CI 1.28 to 3.65; NNTB 4; 2 studies, n=124), and more had reduced inflammation at this time point with high-dose colchicine (504 per 1000 vs. 48 per 1000; RR 10.50, 95% CI 1.48 to 74.38; NNTB 3; 1 study, n=43), but more adverse events were reported with high-dose colchicine (829 per 1000 vs. 260 per 1000; RR 3.21, 95% CI 2.01 to 5.11; 2 studies, n=124). There was little or no difference in treatment success at 32 to 36 hours between high-dose and low-dose colchicine (RR 0.87, 95% CI 0.56 to 1.36; 1 study, n=126), but more adverse events associated with the higher dose (RR 2.11, 95% CI 1.51 to 2.95).
There was no benefit of low-dose colchicine over NSAIDs in terms of treatment success (RR 0.97, 95% CI 0.82 to 1.15; 1 study, n=399) and pain reduction at 7 days, with a similar number of adverse events reported at 4 weeks follow-up (RR 1.07, 95% CI 0.88 to 1.29).
Primary/Secondary Keywords