Safety of colchicine use in clinical practice: illusions and reality
https://doi.org/10.14412/1996-7012-2025-6-117-121
Abstract
Colchicine – an alkaloid isolated from the corms of Colchicum autumnale – is a potent pharmacological agent used in the treatment of various conditions. Its clinical efficacy, confirmed by numerous studies, raises no doubts within the scientific community. Nevertheless, despite the proven therapeutic properties of colchicine, its safety remains surrounded by myths and prejudices. In this work, we attempted to refute these myths, relying on modern scientific data and methodological approaches.
Supporting agencies: The article was prepared within the framework of the basic scientific project “Development of approaches to phenotyping autoinflammatory degenerative rheumatic diseases based on a comparative study of biochemical, immunological and genetic factors associated with the condition of bone, cartilage, muscle and adipose tissues” № 125020501433-4. The investigation has not been sponsored
About the Authors
M. N. Chikina
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Moscow 34A, Kashirskoe Shosse, Moscow 115522
M. S. Eliseev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Maksim Sergeyevich Eliseev
Moscow 34A, Kashirskoe Shosse, Moscow 115522
Ya. I. Kuzmina
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Moscow 34A, Kashirskoe Shosse, Moscow 115522
References
1. Hartung EF. History of the use of colchicum and related medicaments in gout; with suggestions for further research. Ann Rheum Dis. 1954 Sep;13(3):190-200. doi:10.1136/ard.13.3.190.
2. Eliseev MS, Kuzmina YaI, Nasonov EL. Gout in history of humanity. Nauchno-prakticheskaya revmatologiya. 2024;62(3):254-261. (In Russ.).
3. Alekberova ZS, Nasonov EL. Prospects for using colchicine in medicine: new evidence. Nauchno-prakticheskaya revmatologiya. 2020; 58(2):183-190. (In Russ.).
4. Dalbeth N, Lauterio TJ, Wolfe HR. Mechanism of action of colchicine in the treatment of gout. Clin Ther. 2014 Oct 1; 36(10):1465-1479. doi:10.1016/j.clinthera.2014.07.017.
5. Chikina MN. Prevention of arthritis attacks in the use of urate-lowering therapy in patients with gout. Nauchno-prakticheskaya revmatologiya. 2018;56(6):760-766. (In Russ.).
6. Yang LP. Oral colchicine (Colcrys®) in the treatment and prophylaxis of gout: profile report. Drugs Aging. 2010 Oct 1;27(10):855-857. doi:10.2165/11206330-000000000-00000.
7. Angelidis C, Kotsialou Z, Kossyvakis C, et al. Colchicine Pharmacokinetics and Mechanism of Action. Curr Pharm Des. 2018;24(6):659-663. doi:10.2174/1381612824666180123110042.
8. Terkeltaub RA, Furst DE, Bennett K, et al. High versus low dosing of oral colchicine for early acute gout flare: Twenty-four-hour outcome of the first multicenter, randomized, double-blind, placebo-controlled, parallelgroup, dose-comparison colchicine study. Arthritis Rheum. 2010 Apr;62(4):1060-1068. doi:10.1002/art.27327.
9. Wortmann RL, Macdonald PA, Hunt B, Jackson RL. Effect of prophylaxis on gout flares after the initiation of urate-lowering therapy: analysis of data from three phase III trials. Clin Ther. 2010 Dec;32(14):2386-2397. doi:10.1016/j.clinthera.2011.01.008.
10. Saseen JJ, Agashivala N, Allen RR, et al. Comparison of patient characteristics and gout-related health-care resource utilization and costs in patients with frequent versus infrequent gouty arthritis attacks. Rheumatology (Oxford). 2012 Nov;51(11):2004-2012. =doi:10.1093/rheumatology/kes183.
11. Chikina MN, Eliseev MS, Zhelyabina OV. Comparison of the efficacy and safety of various anti-inflammatory drugs in urate-lowering therapy initiation in patients with gout (preliminary data). Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2021;15(2): 50-56. (In Russ.). doi:10.14412/1996-7012-2021-2-50-56.
12. Eliseev MS, Chikina MN, Zhelyabina OV. Colchicine for acute arthritis attacks prevention in patients with gout during urate-lowering therapy (results of a pilot study). Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2021;15(4):50-55. (In Russ.). doi:10.14412/1996-7012-2021-4-50-55.
13. Eliseev MS, Chikina MN, Zhelyabina OV, Kuzmina YaI, Panina EV, Nasonov EL. Efficacy and safety of long-term administration of various doses of colchicine in patients with gout. Nauchno-prakticheskaya revmatologiya. 2025;63(2):197-201. (In Russ.).
14. https://cr.minzdrav.gov.ru/view-cr/936_1.
15. Voulgari PV, Venetsanopoulou AI, Drosos AA. Recent advances in the therapeutic management of calcium pyrophosphate deposition disease. Front Med (Lausanne). 2024 Mar 11;11:1327715. doi:10.3389/fmed.2024.1327715.
16. Rochdi M, Sabouraud A, Girre C, et al. Pharmacokinetics and absolute bioavailability of colchicine after i.v. and oral administration in healthy human volunteers and elderly subjects. Eur J Clin Pharmacol. 1994;46(4): 351-354. doi:10.1007/BF00194404.
17. Pascart T, Robinet P, Ottaviani S, et al. Evaluating the safety and short-term equivalence of colchicine versus prednisone in older patients with acute calcium pyrophosphate crystal arthritis (COLCHICORT): an openlabel, multicentre, randomised trial. Lancet Rheumatol. 2023 Sep;5(9):e523-e531. doi:10.1016/S2665-9913(23)00165-0.
18. McKenzie BJ, Wechalekar MD, Johnston RV, et al. Colchicine for acute gout. Cochrane Database Syst Rev. 2021 Aug 26; 8(8):CD006190. doi:10.1002/14651858.CD006190.pub3.
19. Wan H, Zeng L, Xiao R, et al. Colchicine linked with risk reduction for myocardial infarction in gout patients: systematic review and meta-analysis. Z Rheumatol. 2022 Aug; 81(6):501-506. doi: 10.1007/s00393-022-01232-2.
20. Nasonov EL. Modern concept of autoimmunity in rheumatology. Nauchno-prakticheskaya revmatologiya. 2023;61(4):397-420. (In Russ.).
21. Imazio M, Brucato A, Maestroni S, et al. Prevalence of C-reactive protein elevation and time course of normalization in acute pericarditis: implications for the diagnosis, therapy, and prognosis of pericarditis. Circulation. 2011 Mar 15;123(10):1092-1097. doi:10.1161/CIRCULATIONAHA.110.986372.
22. Imazio M, Brucato A, Cemin R, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med. 2013 Oct 17; 369(16):1522-1528. doi:10.1056/NEJMoa1208536.
23. Sambola A, Roca Luque I, Merce J, et al. Colchicine Administered in the First Episode of Acute Idiopathic Pericarditis: A Randomized Multicenter Open-label Study. Rev Esp Cardiol (Engl Ed). 2019 Sep;72(9):709-716. doi:10.1016/j.rec.2018.11.016.
24. Imazio M, Brucato A, Cemin R, et al. Colchicine for recurrent pericarditis (CORP): a randomized trial. Ann Intern Med. 2011 Oct 4;155(7):409-414. doi:10.7326/0003-4819-155-7-201110040-00359.
25. Imazio M, Belli R, Brucato A, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet. 2014 Jun 14;383(9936):2232-2237. doi:10.1016/S0140-6736(13)62709-9.
26. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42): 2921-2964. doi:10.1093/eurheartj/ehv318.
27. Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol. 2013 Jan 29;61(4):404-410. doi:10.1016/j.jacc.2012.10.027.
28. Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020 Nov 5;383(19): 1838-1847. doi:10.1056/NEJMoa2021372.
29. Fedorov ES, Salugina SO, Kuzmina NN. Familial Mediterranean fever (a periodic disease): The present-day view of the problem. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2013;7(1):24-30. (In Russ.). doi:10.14412/1996-7012-2013-2363.
30. Gattorno M, editor. Familial Mediterranean Fever. Cham: Springer; 2015. 162 p.
31. Goldfinger SE. Colchicine for familial Mediterranean fever. N Engl J Med. 1972 Dec 21;287(25):1302. doi:10.1056/NEJM197212212872514.
32. Ozkan E, Okur O, Ekmekci A, et al. A new approach to the treatment of periodic fever. Med Bull Istanbul. 1972;(5):44–49.
33. Ozen S, Sa E, Oton T, et al. EULAR/PReS endorsed recommendations for the management of familial Mediterranean fever (FMF): 2024 update. Ann Rheum Dis. 2025 Jun;84(6):899-909. doi:10.1016/j.ard.2025.01.028.
34. Berkun Y, Wason S, Brik R, et al. Pharmacokinetics of colchicine in pediatric and adult patients with familial Mediterranean fever. Int J Immunopathol Pharmacol. 2012 Oct-Dec;25(4):1121-1130. doi:10.1177/039463201202500429.
35. Indraratna PL, Virk S, Gurram D, Day RO. Use of colchicine in pregnancy: a systematic review and meta-analysis. Rheumatology (Oxford). 2018 Feb 1;57(2):382-387. doi:10.1093/rheumatology/kex353.
36. Rüegg L, Pluma A, Hamroun S, et al. EULAR recommendations for use of antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025 Jun;84(6):910-926. doi:10.1016/j.ard.2025.02.023. Epub 2025 Apr 26.
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For citations:
Chikina MN, Eliseev MS, Kuzmina YI. Safety of colchicine use in clinical practice: illusions and reality. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2025;19(6):117-121. (In Russ.) https://doi.org/10.14412/1996-7012-2025-6-117-121
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