ULT and Colchicine: How Are They Used Together?

ULT and colchicine

If you suffer with gout, you may take a uric-acid lowering therapy (ULT) such as allopurinol, Uloric (febuxostat), Zurampic® (lesinurad) or Krystexxa® (pegloticase).1-4 These medications have been shown to be a key part of gout flare prevention because they can reduce the amount of uric acid in the bloodstream.1-4,5

ULT represents just one part of therapy, however.6 Many people with gout take ULT and colchicine or another anti-inflammatory medicine as part of their gout flare prevention treatment program.6

 

Understanding gout

Gout is a type of inflammatory arthritis that results from too much uric acid building up in the body, leading to sudden and severe pain, redness and swelling in the joints.7 The disease affects more than 8 million Americans.7

Uric acid builds up over time, so it may take months or even years for symptoms to first appear.8 Once the initial attack has occurred, however, flares usually become more frequent and more painful.7 They eventually begin to occur regularly, with pain that is more severe and long-lasting.7,8 Joints may also be damaged, which can lead to lost mobility.7 These are just some of the reasons why it is so important to gain control of the disease early on—before it becomes chronic.7,8

 

The importance of ULT

The goals of long-term gout management are to reduce the amount of uric acid in the bloodstream, help dissolve uric acid crystals, reduce the risk of recurrent gout flares, break down tophi (chalk-like deposits under the skin that covers the affected joints) and prevent joint damage.5

The American College of Rheumatology (ACR) recommends a “treat to target” strategy.5 This strategy was devised to help people with gout achieve a uric acid level of less than 6 mg/dL of blood.5 A target uric acid level lower than 5 mg/dL of blood is recommended for people with more severe or aggressive gout.5  

 

The link between ULTs and gout flares

As the ULT reduces the amount of uric acid in the bloodstream, urate crystals in the joints begin to dissolve.5 When the urate crystals start to dissolve, a gout flare can occur.5 Fortunately, when used as directed by a doctor, anti-inflammatory medicines such as colchicine can help prevent gout flares in adults who are beginning ULT.5

 

Preventing gout flares with ULT and colchicine

The ACR Guidelines for Management of Gout suggest that patients begin an anti-inflammatory medicine before or during ULT.6 Specifically, the ACR recommends low-dose colchicine (0.5 to 0.6 mg orally once or twice a day) as an option for gout flare prevention in adults.6 Research showing the flare prevention benefits of adding colchicine to ULT date as far back as the 1960s.5

 

Talk with your doctor

If you are taking ULT and still suffering with gout flares, talk with your doctor. Your doctor will be able to offer treatment options that best meet your individual needs and help you avoid the pain of gout flares. You may want to download and complete the Doctor Visit form (from Resources for Patients) before your appointment.

 

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NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not West-Ward’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

References

  1. Allopurinol Tablets, USP [prescribing information]. Memphis, TN: Northstar Healthcare Holdings; 2016.
  2. Uloric (febuxostat) [prescribing information]. Deerfield, IL: Takeda Pharmaceuticals America, Inc; 2013.
  3. ZURAMPIC® (lesinurad) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2015.
  4. KRYSTEXXA® (pegloticase injection) [prescribing information]. Lake Forest, IL: Horizon Pharma Rheumatology LLC; 2016.
  5. Aung T, Myung G, FitzGerald JD. Treatment approaches and adherence to urate-lowering therapy for patients with gout. Patient Prefer Adherence. 2017;11:795–800.
  6. Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. Arthritis Care Res (Hoboken). 2012;64:1447–1451 and 1456–1459.
  7. What Is Gout? Arthritis Foundation website. Available at: https://www.arthritis.org/about-arthritis/types/gout/what-is-gout.php. Accessed March 31, 2018.
  8. Gout/What is gout? CDC website. Available at: https://www.cdc.gov/arthritis/basics/gout.html. Accessed March 31, 2018.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Columbus Inc., Columbus, OH 43228

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.