This Colcrys dosage report is a layman’s summary of an investigation into suspected unnecessary prescribing of high cost Colcrys, presented at the 2012 ACR meeting.
Colcrys is a brand of colchicine. In fact, it is *the* brand given the exclusive license granted by the FDA. We have had many long and often heated discussions about this. Disregarding opinions about the morality of the decision, I want to focus on the facts. I will summarize the study first, then offer a glimmer of hope to those gout patients who cannot afford Colcrys.
Colcrys Dosage Study
- Evaluating Appropriate Use of Prophylactic Colchicine and Urate Lowering Therapy in Gout
- Michael George, Hospital of the University of Pennsylvania, Philadelphia, PA, Sally W. Pullman-Mooar, University of Pennsylvania and Philadelphia Veterans Hospital, Philadelphia, PA and H. Ralph Schumacher, University of Pennsylvania and VA Medical Center, Philadelphia, PA
- ACR Annual Meeting Nov 2012
Colcrys Dosage Study: Background/Purpose
Colchicine ought to be used during uric acid lowering treatment to prevent, or reduce, gout attacks. It should be used:
- At the start of treatment (most effectively a few days before)
- Whenever uric acid lowering medicine dose is increased
This should continue until uric acid reaches 5mg/dL. The authors do not state how long colchicine should be taken for. My doctor recommended 2 weeks, and I found one week to be effective.
This study notes the following problems with colchicine prescriptions:
- Given without adequate uric acid lowering treatment
- Continued after uric acid has reached safe levels
- Dramatically increased in cost since it became Colcrys in the USA
These problems underline the importance of the study, which aims to:
- Examine current prescribing practices
- Identify what drives these practices
- Promote appropriate colchicine use
Colcrys Dosage Study: Methods
193 patients were studied who had prescriptions for colchicine, and 126 were selected who used it for preventative purposes. These were analyzed into appropriate and inappropriate groups. The colchicine prescription was deemed inappropriate for any of the following reasons:
- Uric acid lowering treatment was not prescribed
- Uric acid was not at goal and uric acid lowering therapy had not been started or increased in the past 3 months
- Uric acid goals were met for beyond 1 year and flares had resolved in the absence of tophi
The researchers performed some statistical analysis of characteristics of the people in each group.
Colcrys Dosage Study: Results
33 of the 126 patients were prescribed appropriately. The inappropriate groups were divided as followss:
- 34 : Uric acid lowering treatment was not prescribed
- 50 : Uric acid was not at goal and uric acid lowering therapy had not been started or increased in the past 3 months
- 9 : Uric acid goals were met for beyond 1 year and flares had resolved in the absence of tophi
Patients appropriately prescribed colchicine were younger, had shorter time on colchicine, and were more likely to have been seen by Rheumatology as opposed to being managed solely by primary care.
Colcrys Dosage Study: Conclusion
There is a high incidence of inappropriate preventative colchicine use. The main reasons are failure to prescribe any, or enough uric acid lowering medications. Rheumatologists performed better than primary care physicians. The researchers believe doctors need educating to avoid unnecessary colchicine exposure and to reduce excessive health care system costs.
Colcrys Dosage: Next Steps
Although there are alternatives to colchicine, when used wisely, it can make a real difference. I say used wisely because I see little point in taking colchicine just to treat gout pain. As these researchers state, colchicine should be used as a preventative measure during the relevant stages of uric acid lowering therapy. There it can make the difference between completing the treatment plan with safe uric acid levels, or abandoning the plan due to pain from gout flares. Abandoning the plan is dangerous, as the gout flares will return anyway, and also the excess uric acid will destroy joints.
If you can afford colchicine, use it wisely to support uric acid lowering. If you cannot afford it, please see the assistance programs on www.needymeds.org/. As well as finding free Colcrys, you may also get help with all aspects of gout care, and general medical care.
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