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Research ArticleGout

Examining the Characteristics of Colchicine-Induced Myelosuppression in Clinical Cases: A Systematic Review

Bernice L. Sim, Beatrice Z. Sim, Matthew Tunbridge, David F.L. Liew and Philip C. Robinson
The Journal of Rheumatology March 2023, 50 (3) 400-407; DOI: https://doi.org/10.3899/jrheum.220524
Bernice L. Sim
1B.L. Sim, BSc, MPH, St George’s Hospital Medical School, London, UK;
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Beatrice Z. Sim
2B.Z. Sim, BSc, MBBS, M. Tunbridge, BSc, MBBS, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia;
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Matthew Tunbridge
2B.Z. Sim, BSc, MBBS, M. Tunbridge, BSc, MBBS, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia;
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David F.L. Liew
3D.F.L. Liew, MBBS, Department of Rheumatology and Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, and Department of Medicine, University of Melbourne, Parkville, Victoria, Australia;
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Philip C. Robinson
4P.C. Robinson, MBChB, PhD, The University of Queensland Faculty of Medicine, School of Medicine, Royal Brisbane Hospital Herston, and Royal Brisbane and Women’s Hospital, Department of Rheumatology, Herston, Queensland, Australia.
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Abstract

Objective The use of colchicine has been associated with varying degrees of myelosuppression. Despite expanded use in cardiovascular and inflammatory conditions, there remains clinician concern because of potential myelosuppressive side effects. A systematic review was conducted to explore the reported myelosuppressive events of colchicine.

Methods A systematic review was conducted using the MeSH terms (“colchicine”) AND (“myelosuppression,” “bone*,” “marrow,” “suppression,” “aplasia,” “leukopenia/leucopenia,” “lymphopenia,” “neutropenia”) on September 1, 2020, and was updated on November 30, 2021. The search was conducted in PubMed, ScienceDirect, Scopus, Embase, and Cochrane Library. The search included references published from 1978 to 2020 and was limited to English-language observational studies (ie, case reports, case series, case control studies, and cohort studies) or trial data.

Results In total, 3233 articles were screened, with 30 studies of 47 patients with myelosuppression from colchicine identified. Most patients with myelosuppression had comorbidities, including renal impairment (21/47, 44.7%). Out of 47 patients, 15 (31.9%) and 13 (27.7%) were reported to be concurrently taking cytochrome P450 3A4 (CYP3A4) inhibitors and P-glycoprotein (P-gp) efflux transporter inhibitors, respectively. Patients with renal impairment accounted for the majority of overall patients taking these CYP3A4 and P-gp inhibitors (8/15, 53.3%, and 8/13, 61.5%, respectively). Out of 21 patients with renal impairment, 13 had worsening cytopenia during colchicine use. The presentations ranged from moderate anemia (grade 2) to severe thrombocytopenia, neutropenia, and leukopenia (grade 4).

Conclusion Colchicine has few reports of myelosuppression. The majority of patients with myelosuppression had preexisting renal impairment or concomitant CYP3A4 or P-gp inhibitor use. Caution should be taken in this subset of patients with increased monitoring.

Key Indexing Terms:
  • anemia
  • cardiovascular diseases
  • colchicine
  • evidence-based medicine
  • gout
  • thrombocytopenia
  • Accepted for publication August 8, 2022.
  • Copyright © 2023 by the Journal of Rheumatology
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1 Mar 2023
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Examining the Characteristics of Colchicine-Induced Myelosuppression in Clinical Cases: A Systematic Review
Bernice L. Sim, Beatrice Z. Sim, Matthew Tunbridge, David F.L. Liew, Philip C. Robinson
The Journal of Rheumatology Mar 2023, 50 (3) 400-407; DOI: 10.3899/jrheum.220524

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Examining the Characteristics of Colchicine-Induced Myelosuppression in Clinical Cases: A Systematic Review
Bernice L. Sim, Beatrice Z. Sim, Matthew Tunbridge, David F.L. Liew, Philip C. Robinson
The Journal of Rheumatology Mar 2023, 50 (3) 400-407; DOI: 10.3899/jrheum.220524
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Keywords

ANEMIA
CARDIOVASCULAR DISEASES
COLCHICINE
EVIDENCE-BASED MEDICINE
GOUT
THROMBOCYTOPENIA

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Keywords

  • anemia
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  • gout
  • thrombocytopenia

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