RT Journal Article SR Electronic T1 Examining the Characteristics of Colchicine-Induced Myelosuppression in Clinical Cases: A Systematic Review JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP jrheum.220524 DO 10.3899/jrheum.220524 A1 Bernice L. Sim A1 Beatrice Z. Sim A1 Matthew Tunbridge A1 David F.L. Liew A1 Philip C. Robinson YR 2022 UL http://www.jrheum.org/content/early/2022/09/01/jrheum.220524.abstract AB 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 due to potential myelosuppressive side effects. A systematic review was conducted to explore the reported adverse myelosuppressive events of colchicine. Methods A systematic review was conducted using the MeSH subheading ("colchicine") AND ("myelosuppression", "bone*", "marrow", "suppression", "aplasia", "leukopenia/leucopenia", "lymphopenia", "neutropenia") on 1 September 2020 and was updated on 30th November 2021 for PubMed, Science Direct, Scopus, EMBASE and Cochrane. The search included references from 1978 to 2020, and was limited to English language observational studies (case reports, case series, case control and cohort studies) or trial data. Results Three thousand, two hundred and thirty-three 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%). 15/47 (31.9%) and 13/47 (27.7%) patients were reported to be concurrently taking Cytochrome P450 inhibitors (CYP3A4) and P-glycoprotein efflux transporter inhibitors (P-gp) 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). Thirteen out of twenty-one patients with renal impairment had worsening cytopenias during colchicine use. The presentations ranged from moderate anaemia (Grade 2) to severe thrombocytopenia, neutropenia, and leukopenia (Grade 4). Conclusion Colchicine has few reports of myelosuppression. The majority had pre-existing renal impairment or concomitant CYP3A4 or P-gp inhibitor use. Caution should be taken in this subset of patients with increased monitoring.