Colchicine, terug van nooit weggeweest

Abstract

Colchicine: ancient and brand new Colchicine is an alkaloid initially extracted from an autumn crocus. Its use dates back to the 6th century BC, with the first indication being gout. In the last 50 years, further insights into its mechanism of action emerged along with an expansion of the number of indications. Colchicine inhibits the chemotaxis of leukocytes. Recently, it was discovered that in addition to its action on the microtubules, there is also an effect on the NLRP3 inflammasome. Colchicine has a narrow therapeutic index and caution is advised in patients with renal and hepatic failure. It’s a CYP3A4 and P-gp substrate. Therefore, concomitant use with CYP3A4 and P-gp inhibitors is contraindicated given the greatly increased risk of toxicity. Its most frequent side effect is diarrhea and severe intoxications can be lethal. The main rheumatologic indications are the treatment of gout in the acute phase, attack prevention and amyloidosis in familial Mediterranean fever, and ulcerations in Behçet’s disease. The cardiovascular use of colchicine in acute and relapsing/chronic pericarditis has been well established. Recent studies also show a beneficial effect in case of acute and chronic coronary artery disease. Additional studies for the implementation of colchicine for these indications are ongoing.