Safety and adverse effect profile of colchicine in renal impairment: a systematic review of randomised trials

Abstract

Introduction: Colchicine is an anti-inflammatory drug prescribed for numerous medical conditions. Side effects are frequently encountered, particularly gastrointestinal symptoms. Caution and dose reduction are advised in patients with renal impairment because of a presumed increased risk of side effects. This systematic review intends to summarise the available literature to define the adverse effect profile of colchicine used in patients with kidney disease. Methods: We conducted a systematic review of randomised clinical trials seeking to evaluate the association between renal impairment and colchicine toxicity. We limited our search to randomised studies in humans in the English language. We allowed colchicine prescribed for any duration, dose or indication. Results: Our literature search identified a total of 7707 records. Only a single randomised trial was ultimately identified as meeting the inclusion criteria and addressing our research question. In patients with renal impairment, colchicine was not associated with an increased risk of dialysis, time until dialysis, or the incidence of liver function test derangement. We found no data for adverse events such as leukopenia, thrombocytopenia or diarrhoea in the kidney disease subgroup. Data was sparse and of poor quality. Conclusion: It is widely recommended that colchicine dose be reduced in patients with renal impairment due to an increased risk of drug accumulation and side effects. In our study, we failed to identify any robust clinical research substantiating this association. This is the first systematic review of randomised trials to investigate this link. Further research is required before the safety and tolerability of colchicine in renal disease can be confirmed.