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Zeng J, Li Y, Zou Y, Yang Y, Yang T, Zhou Y. Intestinal toxicity alleviation and efficacy potentiation through therapeutic administration of Lactobacillus paracasei GY-1 in the treatment of gout flares with colchicine. Food Funct 2024; 15:1671-1688. [PMID: 38251779 DOI: 10.1039/d3fo04858f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Gout flares have emerged as a significant public health concern. Colchicine (COL) is a first-line and standard drug for treating gout flares. However, its clinical use is limited due to various adverse effects. Besides, COL fails to adequately meet the needs of patients, particularly young patients. In this study, we investigate the therapeutic administration of Lactobacillus paracasei GY-1 (GY-1) to overcome the limitations of COL. Our results demonstrate that GY-1 attenuates COL toxicity in terms of body weight loss, decreased feed intake, mortality, reduced locomotor activity, colon shortening, increased oxidative stress, histological damage, and impaired gut permeability. Meanwhile, we demonstrate that GY-1 enhances the therapeutic effect for gout flares when combined with COL, as evidenced by the reduction in paw swelling, decreased levels of proinflammatory cytokines including IL-1β and TNF-α, and an increase in the anti-inflammatory cytokine IL-10. Additionally, the absolute quantification of the gut microbiota shows that GY-1 restores the gut microbiota imbalance caused by COL. Furthermore, GY-1 reduces the abundance of 4 Alistipes species and 6 Porphyromonadaceae species, which may be responsible for toxicity alleviation. At the same time, GY-1 increases the abundance of Bacteroides sartorii and Enterococcus sp., which may contribute to its therapeutic efficacy. This study demonstrates the feasibility of developing probiotic-based adjuvant therapy or bacteriotherapy for treating gout flares. To our knowledge, GY-1 is the first probiotic that could be used as an alternative synergetic agent with COL for the therapeutic treatment of gout flares.
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Affiliation(s)
- Jiaqi Zeng
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, School of Public Health, Guilin Medical University, Guilin, Guangxi 541199, China.
| | - Yan Li
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, School of Public Health, Guilin Medical University, Guilin, Guangxi 541199, China.
| | - Yizhi Zou
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, School of Public Health, Guilin Medical University, Guilin, Guangxi 541199, China.
| | - Ying Yang
- Department of Public Health, School of Medicine, Guangxi University of Science and Technology, Liuzhou, Guangxi 545005, China
| | - Tingting Yang
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, School of Public Health, Guilin Medical University, Guilin, Guangxi 541199, China.
| | - Yizhuang Zhou
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, School of Public Health, Guilin Medical University, Guilin, Guangxi 541199, China.
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Amaral A, Ferreira da Silva D, Sampaio MB, Salvado C. Colchicine Poisoning: A Rare Case. Cureus 2023; 15:e48933. [PMID: 38106754 PMCID: PMC10725528 DOI: 10.7759/cureus.48933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Intoxication by colchicine is rare, and its rapid recognition is crucial, as severe toxicity or death is reported in 10% of cases. Here, we present the case of a 50-year-old female admitted to the emergency department 24 hours after ingesting 10 mg of colchicine. Upon examination, she was conscious and hemodynamically stable. Analytically, she exhibited leukocytosis with neutrophilia and an elevation of lactate dehydrogenase (LDH). She was initiated on fluid therapy and transferred to the intermediate care unit of medicine. On the third day of hospitalization, she developed anterior chest pain, reduced breath sounds in the right hemithorax, and dullness on percussion. Arterial blood gas analysis showed partial respiratory failure, and chest X-rays and a computed tomography (CT) scan revealed a right-sided pleural effusion. The likely diagnosis was pleural effusion secondary to cardiac dysfunction due to colchicine intoxication. This case aims to describe the potential toxic effects of colchicine in cases of overdose and to reflect on ways to reduce its morbidity and mortality.
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Affiliation(s)
- Andreia Amaral
- Internal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT
| | | | | | - Catarina Salvado
- Internal Medicine, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT
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3
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Arif T, Bicker W, Pöchacker S, Kögler A, Gangl C, Holzer A. Colchicum autumnale intoxications: experience of the Poisons Information Centre, Austria 2002-2018. Clin Toxicol (Phila) 2023; 61:687-692. [PMID: 37917169 DOI: 10.1080/15563650.2023.2272572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Colchicine toxicity can occur when individuals unintentionally pick meadow saffron (Colchicum autumnale) instead of Allium ursinum. This study aimed to assess the severity of poisoning based on readily available clinical laboratory parameters evaluated within the first 24 hours of ingestion. METHODS Data from the Austrian Poisons Information Centre from 2002 to 2018 were evaluated for Colchicum autumnale poisoning and follow-up, including patients' clinical conditions, laboratory values, and serum colchicine concentrations. RESULTS Over the period of 17 years, 174 human cases of suspected Colchicum autumnale poisoning were reported to the Austrian Poisons Information Centre, including 163 cases of unintentional exposure (113 cases <15 years; 50 cases ≥ 15 years old). Follow-up was possible in seven of these cases; two of the patients died. Laboratory tests within the first 24 hours showed increased activities of lactate dehydrogenase (258-1974 U/L), aspartate aminotransferase (71-217 U/L), and creatine kinase (164-559 U/L) in five cases. One patient who consumed a small amount did not have any relevant laboratory changes. In another patient, the first blood sample was taken after 20 hours, which showed elevated aspartate aminotransferase (109 U/L) and lactate dehydrogenase (650 U/L) activities. Blood samples after 26.5 hours showed elevated creatine kinase (277 U/L) activity. Three patients had an elevated troponin concentration within the first 24 to 26.5 hours; one of them died. In five of these seven cases, toxicological analyses confirmed colchicine intoxication (serum colchicine concentration 2.0 - 6.5 µg/L). CONCLUSIONS When the ingestion of Colchicum autumnale is suspected in patients with gastrointestinal symptoms, elevated activities of lactate dehydrogenase, aspartate aminotransferase, and creatine kinase within the first 24 hours, careful monitoring is required. Serum creatinine and troponin concentrations, together with haematological parameters, should be measured to allow better clinical assessment. As only a small number of patients have been reported, further detailed case reports are needed to better predict the prognosis of intoxications with Colchicum autumnale.
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Affiliation(s)
- Tara Arif
- Poisons Information Centre, Vienna, Austria
| | | | | | - Andrea Kögler
- Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Cornelia Gangl
- Pyhrn-Eisenwurzen Klinikum Kirchdorf, Kirchdorf, Austria
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Lancieri M, Bustaffa M, Palmeri S, Prigione I, Penco F, Papa R, Volpi S, Caorsi R, Gattorno M. An Update on Familial Mediterranean Fever. Int J Mol Sci 2023; 24:ijms24119584. [PMID: 37298536 DOI: 10.3390/ijms24119584] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: Familial Mediterranean Fever (FMF) is the prototypal autoinflammatory disease, characterized by recurrent bursts of neutrophilic inflammation. (2) Methods: In this study we look at the most recent literature on this condition and integrate it with novel information on treatment resistance and compliance. (3) Results: The canonical clinical presentation of FMF is in children with self-limited episodes of fever and polyserositis, associated with severe long-term complications, such as renal amyloidosis. It has been described anecdotally since ancient times, however only recently it has been characterized more accurately. We propose an updated overview on the main aspects of pathophysiology, genetics, diagnosis and treatment of this intriguing disease. (4) Conclusions: Overall, this review presents the all the main aspects, including real life outcome of the latest recommendation on treatment resistance of FMF, a disease, that not only helped understanding the pathophysiology of the auto inflammatory process but also the functioning of the innate immune system itself.
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Affiliation(s)
- Maddalena Lancieri
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Marta Bustaffa
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Serena Palmeri
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Ignazia Prigione
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Federica Penco
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Riccardo Papa
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Stefano Volpi
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Roberta Caorsi
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Marco Gattorno
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
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5
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Liu Y, Zhu X, Ji S, Huang Z, Zang Y, Ding Y, Zhang J, Ding Z. Transdermal delivery of colchicine using dissolvable microneedle arrays for the treatment of acute gout in a rat model. Drug Deliv 2022; 29:2984-2994. [PMID: 36101018 PMCID: PMC9487926 DOI: 10.1080/10717544.2022.2122632] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Colchicine (Col) is used to prevent and treat acute gout flare; however, its therapeutic use is strictly limited owing to severe gastrointestinal side effects after oral administration. Therefore, we developed a dissolvable Col-loaded microneedle (MN) with hyaluronic acid to deliver Col via the transdermal route. We studied the preparation, mechanical properties, skin insertion, skin irritation, drug content, and transdermal release of the Col-loaded MN. The pharmacokinetics of Col after Col-loaded MN application were compared with those of Col solution gavage over 24 h. Knee joint edema evaluation and the hindfoot mechanical threshold test were conducted to determine the pharmacodynamic profile. The dissolvable Col-loaded MN possessed sufficient mechanical strength to penetrate the skin and release the loaded drug. No skin irritation was observed for 3 days after application. We found that 3.36-fold more Col contained in MNs was delivered through the skin compared with that in gel in vitro, and moderate relative bioavailability in vivo. The Col-loaded MN significantly relieved swollen knee joints and mechanical hypernociception in an acute gout model in rats. The dissolvable Col-loaded MN array reduced inflammation and pain via topical administration when acute gout occurred. Reducing the gastrointestinal side effects of Col-loaded MNs is expected to optimize the therapeutic effects of Col and improve patient compliance.
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Affiliation(s)
- Yang Liu
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Xiaoruo Zhu
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Shiliang Ji
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
- Department of Pharmacy, Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhen Huang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Yuhui Zang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Ying Ding
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junfeng Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Zhi Ding
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
- Engineering Research Center of Protein and Peptide Medicine, Ministry of Education, Nanjing, China
- Changzhou High-Tech Research Institute of Nanjing University, Changzhou, China
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6
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Perzon O, Kenig A, Fellig Y, Mevorach D. Use of Colchicine for Pericardial Inflammation: Risks and Toxicities-A Cautionary Tale. JACC Case Rep 2022; 4:1449-1452. [PMID: 36388708 PMCID: PMC9663985 DOI: 10.1016/j.jaccas.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023]
Abstract
Colchicine is commonly used as part of the treatment of acute and recurrent pericarditis. Neuromyopathy is a well-known, but probably underreported, side effect of colchicine. Here we present a unique case of a 56-year-old woman with recurrent episodes of colchicine-induced neuromyopathy over many years. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Ofer Perzon
- Department of Internal Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ariel Kenig
- Department of Internal Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yakov Fellig
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dror Mevorach
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Institute of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
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He G, Liu Z, Chen H, Wang Y, Huang W, Lu X, Tian Y, Liu H. Effects of different boiling processes on chemical compositions of Lilii Bulbus soup. Front Nutr 2022; 9:985105. [PMID: 36337618 PMCID: PMC9631303 DOI: 10.3389/fnut.2022.985105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Lilii Bulbus, an edible Chinese herbal medicine, has a long history in medicine. However, research on effectively boiling Lilii Bulbus is rare. To make the more nutritious Lilii Bulbus soup, the optimized boiling process, using an alternate heating mode by decoction pot carrying a mixture of water and Chinese liquor at the ration of 9:1, was established in this study. Compared to the soup prepared by the daily process, the polysaccharide amount improved by 54%, and the total heavy metals decreased by 33.5% using the optimized boiling process. In addition, the total saponins at 34.3 μg/g were determined in the soup prepared by the optimized process. Meanwhile, the colchicine content in the boiled Lilii Bulbus soup was undetectable using the optimized process. This research performs an optimized boiling process for making Lilii Bulbus soup, and provides a reference for generating high commercial value from Lilii Bulbus soup in the future.
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Affiliation(s)
- Guowei He
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
| | - Ziying Liu
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
| | - Hong Chen
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
| | - Yuhui Wang
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
| | - Wei Huang
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
| | - Xiangyang Lu
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
| | - Yun Tian
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
- State Key Laboratory of Utilization of Woody Oil Resource, Hunan Academy of Forestry, Changsha, China
- *Correspondence: Yun Tian,
| | - Huhu Liu
- College of Bioscience and Biotechnology, Hunan Agricultural University, Changsha, China
- Huhu Liu,
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8
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Wu J, Liu Z. Progress in the management of acute colchicine poisoning in adults. Intern Emerg Med 2022; 17:2069-2081. [PMID: 36028733 PMCID: PMC9417090 DOI: 10.1007/s11739-022-03079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
Colchicine is a tricyclic, lipid-soluble alkaloid which has long been used to treat gout and many immunological diseases. Due to its narrow therapeutic window and long half-life of elimination, colchicine overdose occurs occasionally. Unfortunately, some patients lost their lives because of colchicine overdose or suicide. Acute colchicine poisoning can lead to original gastrointestinal disorders, shock, progressive multiple organ failure, and myelosuppression. Although many researchers in the world performed lots of research, there are currently no specific antidotes for colchicine poisoning. Meanwhile, there are no management guidelines to treat patients with acute colchicine poisoning until now. Herein, we systematically elaborate on the clinical features and progress in the management of acute colchicine poisoning in adults according to the previous literature. This paper will provide some valuable and available information for clinicians.
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Affiliation(s)
- Jiacheng Wu
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Zhenning Liu
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
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González L, Bulnes JF, Orellana MP, Muñoz Venturelli P, Martínez Rodriguez G. The Role of Colchicine in Atherosclerosis: From Bench to Bedside. Pharmaceutics 2022; 14:pharmaceutics14071395. [PMID: 35890291 PMCID: PMC9323936 DOI: 10.3390/pharmaceutics14071395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 02/06/2023] Open
Abstract
Inflammation is a key feature of atherosclerosis. The inflammatory process is involved in all stages of disease progression, from the early formation of plaque to its instability and disruption, leading to clinical events. This strongly suggests that the use of anti-inflammatory agents might improve both atherosclerosis progression and cardiovascular outcomes. Colchicine, an alkaloid derived from the flower Colchicum autumnale, has been used for years in the treatment of inflammatory pathologies, including Gout, Mediterranean Fever, and Pericarditis. Colchicine is known to act over microtubules, inducing depolymerization, and over the NLRP3 inflammasome, which might explain its known anti-inflammatory properties. Recent evidence has shown the therapeutic potential of colchicine in the management of atherosclerosis and its complications, with limited adverse effects. In this review, we summarize the current knowledge regarding colchicine mechanisms of action and pharmacokinetics, as well as the available evidence on the use of colchicine for the treatment of coronary artery disease, covering basic, translational, and clinical studies.
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Affiliation(s)
- Leticia González
- Centro de Imágenes Biomédicas, Departamento de Radiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile;
- Instituto Milenio de Ingeniería e Inteligencia Artificial para la Salud, iHEALTH, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - Juan Francisco Bulnes
- División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (J.F.B.); (M.P.O.)
| | - María Paz Orellana
- División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (J.F.B.); (M.P.O.)
| | - Paula Muñoz Venturelli
- Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad de Desarrollo, Santiago 7610658, Chile;
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2042, Australia
| | - Gonzalo Martínez Rodriguez
- División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile; (J.F.B.); (M.P.O.)
- Correspondence:
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Rousseau G, Clément J, Fezard JB, Laribi S. [Colchicum poisoning by confusion with wild garlic (Allium ursinum)]. Rev Med Interne 2022; 43:559-561. [PMID: 35597736 DOI: 10.1016/j.revmed.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Colchicine poisoning is a life-threatening intoxication. CASE REPORT We report a case of food poisosing with Colchicum autumnale by confusion with wild garlic. The clinical presentation is the same as that of colchicine drug intoxication. The evolution can be fatal in case of massive ingestion. The proximity of the place of growth and their similar appearance in spring make Colchicum and wild garlic plants that can easily be confused. CONCLUSION Physicians have to be vigilant in case of dysenteric syndrome and biological disturbances in spring and look for the consumption of perennial plant preceding symptoms.
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Affiliation(s)
- G Rousseau
- Département de médecine d'urgences, CHRU Tours, Tours, France.
| | - J Clément
- Département de médecine d'urgences, CHRU Tours, Tours, France; Université de Tours, Tours, France
| | - J B Fezard
- Département de médecine d'urgences, CHRU Tours, Tours, France
| | - S Laribi
- Département de médecine d'urgences, CHRU Tours, Tours, France; Université de Tours, Tours, France
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Liu YQ, Lu XX, Hu KX, Peng XB, Jiang Y, Han LM, Ma ZQ, Peng MF, Wan K, Zhang XG, Qiu ZW. Dynamic observation of bone marrow suppression and chromosomal aberrations in patients with acute colchicine poisoning. World J Emerg Med 2022; 13:130-134. [PMID: 35237367 DOI: 10.5847/wjem.j.1920-8642.2022.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/26/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yan-Qing Liu
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Xiao-Xia Lu
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.,Academy of Military Medical Sciences, Academy of Military Sciences, Beijing 100850, China
| | - Kai-Xun Hu
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Xiao-Bo Peng
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Yun Jiang
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Li-Mei Han
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Zhi-Qiang Ma
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Ming-Fei Peng
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Kun Wan
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Xi-Gang Zhang
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Ze-Wu Qiu
- Poisoning Treatment Department, Department of Hematology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
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Keiner M, Dreller V, Klemm I, Lehmann H. [Accidental colchicine intoxication in a cross-breed dog]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:46-56. [PMID: 35235962 DOI: 10.1055/a-1696-3847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 2-year old cross-breed dog presented due to acute vomiting and progressive lethargy following ingestion of the owner's anti-gout medication (colchicine, 0.35 mg/kg) 1-3 hours prior to presentation.The dog developed signs of all 3 stages of colchicine poisoning (gastrointestinal phase, multi-organ phase, recovery phase) and the clinical course was complicated by the presence of multi-organ dysfunction syndrome (MODS) and numerous negative prognostic factors.This case report describes the clinical and laboratory effects of colchicine poisoning and represents the first successful treatment of an accidental colchicine ingestion in a dog in Europe.
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Affiliation(s)
- Miriam Keiner
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
| | - Vanessa Dreller
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
| | - Isabelle Klemm
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
| | - Hendrik Lehmann
- Klinikum Veterinärmedizin, Klinik für Kleintiere, Innere Medizin, Justus-Liebig-Universität Gießen
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Kofler T, Kurmann R, Lehnick D, Cioffi GM, Chandran S, Attinger-Toller A, Toggweiler S, Kobza R, Moccetti F, Cuculi F, Jolly SS, Bossard M. Colchicine in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Trials. J Am Heart Assoc 2021; 10:e021198. [PMID: 34369166 PMCID: PMC8475038 DOI: 10.1161/jaha.121.021198] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inflammation plays a pivotal role in coronary artery disease (CAD). The anti‐inflammatory drug colchicine seems to reduce ischemic events in patients with CAD. So far there is equipoise about its safety and impact on mortality. Methods and Results To evaluate the utility of colchicine in patients with acute and chronic CAD, we performed a systematic review and meta‐analysis. MEDLINE, EMBASE, Cochrane CENTRAL and conference abstracts were searched from January 1975 to October 2020. Randomized trials assessing colchicine compared with placebo/standard therapy in patients with CAD were included. Data were combined using random‐effects models. The reliability of the available data was tested using trial sequential analyses . Of 3108 citations, 13 randomized trials (n=13 125) were included. Colchicine versus placebo/standard therapy in patients with CAD reduced risk of myocardial infarction (odds ratio [OR] 0.64; 95% CI, 0.46–0.90; P=0.01; I2 41%) and stroke/transient ischemic attack (OR 0.50; 95% CI, 0.31–0.81; P=0.005; I2 0%). But treatment with colchicine compared with placebo/standard therapy had no influence on all‐cause and cardiovascular mortality (OR 0.96; 95% CI, 0.65–1.41; P=0.83; I2 24%; and OR 0.82; 95% CI, 0.55–1.22; P=0.45; I2 0%, respectively). Colchicine increased the risk for gastrointestinal side effects (P<0.001). According to trial sequential analyses, there is only sufficient evidence for a myocardial infarction risk reduction with colchicine. Conclusions Among patients with CAD, colchicine reduces the risk of myocardial infarction and stroke, but has a higher rate of gastrointestinal upset with no influence on all‐cause mortality.
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Affiliation(s)
- Thomas Kofler
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Reto Kurmann
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Dirk Lehnick
- Department of Biostatistics and Methodology CTU-CS University of Lucerne Lucerne Switzerland
| | | | - Sujay Chandran
- Royal Sussex County Hospital Sussex Worthing United Kingdom
| | | | - Stefan Toggweiler
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Richard Kobza
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Federico Moccetti
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Florim Cuculi
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
| | - Sanjit S Jolly
- McMaster UniversityHamilton Health Sciences Hamilton Ontario Canada
| | - Matthias Bossard
- Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland
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14
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Lu X, Liu Y, Wang C, Dong J, Bai L, Zhang C, Zhang R, Sun C, Qiu Z. Pathogenic characteristics and treatment in 43 cases of acute colchicine poisoning. Toxicol Res (Camb) 2021; 10:885-892. [PMID: 34484680 PMCID: PMC8403592 DOI: 10.1093/toxres/tfab074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 11/12/2022] Open
Abstract
Colchicine poisoning is complicated and has a high mortality rate. The aim of this study was to identify the pathogenic characteristics of colchicine poisoning cases and to propose a comprehensive treatment procedure. A total of 43 patients were divided into survival (n = 32) and death groups (n = 11) according to prognosis. The clinical data (basic information, clinical manifestations, laboratory tests, examination results, therapeutic schedule, response evaluation, and prognosis) were analyzed, and the comprehensive treatment was proposed. The ingestion doses were ≤0.5, 0.5-0.8, and ≥0.8 mg/kg, and the survival rates were 100, 83.33, and 28.60%. The causes of death were cardiovascular and bone marrow hematopoietic failures. We found that the order of organ damage was digestive tract, coagulation, muscle, heart, hematopoietic, lung, liver, and kidney, while the recovery order was digestive tract, coagulation, heart, hematopoietic, lung, muscle, kidney, and liver. Different doses of recombinant human granulocyte colony-stimulating factor and recombinant human thrombopoietin can shorten the severity and duration of neutropenia and thrombocytopenia. Plasma exchange combined with continuous veno-venous hemodialysis filtration treatment can increase survival time. The prognosis is positively correlated with the dose. Early removal of toxicants from the digestive tract and blood is essential. It is vital to give comprehensive treatment of multiple organ injuries, include the use of recombinant human granulocyte colony-stimulating factor, recombinant human thrombopoietin, plasma exchange, and continuous veno-venous hemodialysis filtration.
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Affiliation(s)
- Xiaoxia Lu
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
- Academy of Military Medical Sciences, Academy of Military Sciences, No. 27 North Taiping Road, Beijing 100850, China
| | - Yanqing Liu
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
| | - Chunyan Wang
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
| | - Jianguang Dong
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
| | - Lili Bai
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
| | - Chengcheng Zhang
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
| | - Renzheng Zhang
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
| | - Chengwen Sun
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
| | - Zewu Qiu
- Poisoning Treatment Department, Department of Hematology, Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dong da Street, Fengtai District, Beijing 100071, China
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15
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Karatza E, Ismailos G, Karalis V. Colchicine for the treatment of COVID-19 patients: efficacy, safety, and model informed dosage regimens. Xenobiotica 2021; 51:643-656. [PMID: 33845715 PMCID: PMC8054498 DOI: 10.1080/00498254.2021.1909782] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
Colchicine is widely investigated for cardioprotection of COVID-19 patients since it can prevent the phenomenon of 'cytokine storm' and may reduce the complications arising from COVID-19. Despite the potentially beneficial effects of colchicine, there is no consensus on the appropriate dosage regimen and numerous schemes are currently used.In this study, simulations were performed to identify the ability of dosage regimens to attain plasma levels in CVOID-19 patients, known to be generally safe and efficacious. Since renal and hepatic impairment, as well as, drug-drug interactions have been identified to be the most significant factors increasing colchicine toxicity, the impact of these interactions was assessed in the simulations.Some dosage regimens lead to high colchicine concentrations, while others result in sub-therapeutic levels. Additional dosage schemes were proposed in this study aiming to be applied in patients with clearance insufficiency. Colchicine administration of 0.5 mg twice daily, can be considered safe and effective. In cases of clearance impairment, doses as low as 0.25 mg thrice or twice daily should be applied.Colchicine is a narrow therapeutic index drug and dosage regimens tailored to patients' needs should be designed.
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Affiliation(s)
- Eleni Karatza
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - George Ismailos
- Experimental-Research Center ELPEN, ELPEN Pharmaceuticals, Pikermi, Greece
| | - Vangelis Karalis
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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16
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Pérez Marín M, Prod'hom S, de Villiers SF, Ferry T, Amiet V, Natterer J, Perez MH, Buclin T, Chtioui H, Longchamp D. Case Report: Colchicine Toxicokinetic Analysis in a Poisoned Child Requiring Extracorporeal Life Support. Front Pediatr 2021; 9:658347. [PMID: 33898365 PMCID: PMC8058177 DOI: 10.3389/fped.2021.658347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/15/2021] [Indexed: 12/03/2022] Open
Abstract
Colchicine poisoning is associated with a poor prognosis, especially when leading to shock and multi-organ failure, and management is limited to supportive care, including multiple-dose activated charcoal. At therapeutic concentrations, colchicine elimination occurs mainly through hepatic metabolism and involves an enterohepatic circulation, with a small contribution of renal elimination (10-30%). Colchicine toxicokinetics is however rarely described, especially in children. We present the case of a 4-year-old patient who survived a severe iatrogenic colchicine intoxication with a dose of 0.5 mg/kg. She developed multi-organ failure and shock, but recovered after receiving aggressive resuscitation, including extracorporeal life support. Close monitoring of colchicine blood levels showed a plateau for 6 days, indicating impeded elimination resulting from liver failure. We observed no significant clearance from renal replacement therapy, nor activated charcoal, during this period. Extracorporeal life support may play a supportive role in the management of severe colchicine poisoning. However, extracorporeal techniques do not seem to improve colchicine elimination.
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Affiliation(s)
- Maria Pérez Marín
- Pediatric Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sylvain Prod'hom
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Thomas Ferry
- Pediatric Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vivianne Amiet
- Pediatric Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julia Natterer
- Pediatric Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maria-Helena Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Haithem Chtioui
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David Longchamp
- Pediatric Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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17
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Girard de Courtilles M, Balusson F, Queric C, Bouric S, Carlhant-Kowalski D, Scailteux LM, Polard E. [Drug interactions with colchicine, are the contraindications well respected? A descriptive study of prescriptions in Brittany based on data from the French National Health Data System]. Therapie 2020; 75:675-679. [PMID: 32646688 DOI: 10.1016/j.therap.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/08/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
Although the French Health Authority "ANSM" widely informed healthcare professionals about the risk factors for colchicine overdose, its impact and suitable dosages, cases of potentially fatal preventable overdose continue to be reported in France. Using the French National Health Insurance of the Brittany area, we quantified the proportion of prescriptions presenting an absolute drug contraindication (CI) to colchicine (according to the ANSM Drug Interactions "Thesaurus") and its impact in terms of hospitalisation. Between 2013 and 2016, nearly 77,000 patients (mean age, 66±15 years) were reimbursed for at least one colchicine-based drug (Colchimax®, Colchicine Opocalcium®), representing nearly 205,000 prescriptions. General practitioners were the main prescribers (93%). Among the prescriptions, 0.5% had absolute IC with colchicine: in 51% of cases with pristinamycin, followed by azithromycin (15.6%), clarithromycin (15.2%) and roxithromycin (11.9%). In the 15 days following the simultaneous prescription of colchicine and a contraindicated drug, 53 hospital stays were recorded. However, using only the primary diagnosis of hospitalization was not sufficiently relevant to conclude that there was no potential overdose of colchicine. Over the study period, the Thesaurus contained inconsistencies that confused clinicians: mention of absolute IC with colchicine in the "macrolide" and "pristinamycin" sections but not in the sections of 'potent CYP inhibitors' or macrolide class molecules. Overall, very few prescriptions included absolute IC with colchicine. Regular training and information of healthcare professionals remains essential to limit the risk of colchicine overdose and to remind them of the potentially fatal consequences.
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Affiliation(s)
- Marion Girard de Courtilles
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU Rennes, rue Henri-Le-Guilloux, 35000 Rennes, France
| | | | - Claudine Queric
- Coordination régionale gestion du risque (GDR) Bretagne, CPAM Ille-et-Vilaine, 35000 Rennes, France
| | - Stéphanie Bouric
- Coordination régionale gestion du risque (GDR) Bretagne, CPAM Ille-et-Vilaine, 35000 Rennes, France
| | - Dominique Carlhant-Kowalski
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU Brest, 29609 Brest, France
| | - Lucie-Marie Scailteux
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU Rennes, rue Henri-Le-Guilloux, 35000 Rennes, France; Univ Rennes, EA 7449 REPERES, 35000 Rennes, France.
| | - Elisabeth Polard
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU Rennes, rue Henri-Le-Guilloux, 35000 Rennes, France; Univ Rennes, EA 7449 REPERES, 35000 Rennes, France
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18
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Kacar M, Savic S, van der Hilst JCH. The Efficacy, Safety and Tolerability of Canakinumab in the Treatment of Familial Mediterranean Fever: A Systematic Review of the Literature. J Inflamm Res 2020; 13:141-149. [PMID: 32210604 PMCID: PMC7069573 DOI: 10.2147/jir.s206204] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/20/2020] [Indexed: 11/23/2022] Open
Abstract
Familial Mediterranean Fever (FMF) is the most prevalent genetic autoinflammatory disorder. In most patients, treatment with colchicine can prevent attacks of fever and inflammation. However, 5%-10% of patients are resistant to colchicine treatment, while a similar percentage cannot tolerate colchicine in doses needed to prevent attacks. For these patients, Canakinumab, a full human antibody against IL-1β, has been approved recently by the FDA and EMA. In this article, we present a systematic review of the long-term efficacy, safety, and tolerability of Canakinumab in FMF patients who cannot tolerate colchicine or who are resistant to colchicine treatment.
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Affiliation(s)
- Mark Kacar
- Department of Clinical Immunology and Allergy, St James´s University Hospital, Leeds, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James´s University Hospital, Leeds, UK
| | - Jeroen C H van der Hilst
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.,BIOMED Research Institute, University of Hasselt, Hasselt, Belgium
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19
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Allard M, Soichot M, Leclercq M, Bourgogne E, Jaffal K, Mégarbane B, Labat L. Intoxication à la colchicine : importance des conditions initiales pour la prise en charge. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Garcia-Robledo JE, Aragón CC, Nieto-Aristizabal I, Posso-Osorio I, Cañas CA, Tobón GJ. Tofacitinib for familial Mediterranean fever: a new alternative therapy? Rheumatology (Oxford) 2020; 58:553-554. [PMID: 30535114 DOI: 10.1093/rheumatology/key384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Cristian C Aragón
- Department of Internal Medicine, Universidad Icesi, Medical School, Cali, Colombia
| | - Ivana Nieto-Aristizabal
- Department of Internal Medicine, Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Iván Posso-Osorio
- Department of Internal Medicine, Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Carlos A Cañas
- Department of Internal Medicine, Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Gabriel J Tobón
- Department of Internal Medicine, Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.,Laboratory of Immunology, Fundación Valle Del Lili, Cali, Colombia
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21
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Goodman IH. Survival of a dog with accidental colchicine overdose. J Vet Emerg Crit Care (San Antonio) 2019; 30:74-80. [PMID: 31883205 DOI: 10.1111/vec.12919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 07/04/2018] [Accepted: 08/09/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the treatment and clinical course of a dog accidentally prescribed 10 times the recommended dose of colchicine (0.3 mg/kg/d instead of 0.03 mg/kg/d). CASE SUMMARY After glaucoma surgery, a 1-year-old male neutered Pomeranian weighing 6.8 kg was prescribed 1,000 μg colchicine twice a day per os. The dog presented to the emergency department after the first dose with vomiting and was treated as an outpatient. Two colchicine doses later, the dog represented with vomiting, ocular pain, and increased intraocular pressure. The dog's vital signs were normal, and the dog was admitted for rehydration, analgesia, and revision glaucoma surgery the next day. Two hours after revision surgery, the dog developed vomiting and diarrhea. Postoperatively, the dog was hypothermic (36.3°C), persistently hypertensive (227 mm Hg), and bradycardic (60/min). Biochemistry revealed metabolic acidosis and increased hepatic enzyme activities. Mannitol was administered for presumed cerebral edema. Later, the dog developed bradycardia due to second-degree atrioventricular heart block, which responded to atropine. Total hospitalization was 9 days. Treatment included IV fluids, IV lipid emulsion, N-acetylcysteine, activated charcoal, gastroprotectants, antiemetics, opioids, antimicrobials, and barrier nursing due to transient neutropenia. NEW OR UNIQUE INFORMATION PROVIDED This is the first report to describe the successful treatment of a dog with colchicine overdose. The systemic effects were presumed to be secondary to colchicine toxicosis rather than diet, infection, or other drug reaction, and may have been compounded by a second anesthetic episode. Gastrointestinal signs, symptoms of cerebral edema, cardiac arrhythmias, and neutropenia were documented. One other report of colchicine overdose in a dog exists, and that patient was euthanized. This report demonstrates that complete recovery with intensive care is possible; however, the prognosis remains guarded.
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22
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Desmarais J, Schwab P. Gout Management in Chronic Kidney Disease: Pearls and Pitfalls. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Janssen L, Allard NAE, Saris CGJ, Keijer J, Hopman MTE, Timmers S. Muscle Toxicity of Drugs: When Drugs Turn Physiology into Pathophysiology. Physiol Rev 2019; 100:633-672. [PMID: 31751166 DOI: 10.1152/physrev.00002.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Drugs are prescribed to manage or prevent symptoms and diseases, but may sometimes cause unexpected toxicity to muscles. The symptomatology and clinical manifestations of the myotoxic reaction can vary significantly between drugs and between patients on the same drug. This poses a challenge on how to recognize and prevent the occurrence of drug-induced muscle toxicity. The key to appropriate management of myotoxicity is prompt recognition that symptoms of patients may be drug related and to be aware that inter-individual differences in susceptibility to drug-induced toxicity exist. The most prevalent and well-documented drug class with unintended myotoxicity are the statins, but even today new classes of drugs with unintended myotoxicity are being discovered. This review will start off by explaining the principles of drug-induced myotoxicity and the different terminologies used to distinguish between grades of toxicity. The main part of the review will focus on the most important pathogenic mechanisms by which drugs can cause muscle toxicity, which will be exemplified by drugs with high risk of muscle toxicity. This will be done by providing information on key clinical and laboratory aspects, muscle electromyography patterns and biopsy results, and pathological mechanism and management for a specific drug from each pathogenic classification. In addition, rather new classes of drugs with unintended myotoxicity will be highlighted. Furthermore, we will explain why it is so difficult to diagnose drug-induced myotoxicity, and which tests can be used as a diagnostic aid. Lastly, a brief description will be given of how to manage and treat drug-induced myotoxicity.
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Affiliation(s)
- Lando Janssen
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Neeltje A E Allard
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Christiaan G J Saris
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Jaap Keijer
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Maria T E Hopman
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Silvie Timmers
- Departments of Physiology, Hematology, and Neurology, Radboud University Medical Center, Nijmegen, The Netherlands; and Human and Animal Physiology, Wageningen University & Research, Wageningen, The Netherlands
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Goldberg O, Levinsky Y, Peled O, Koren G, Harel L, Amarilyo G. Age dependent safety and efficacy of colchicine treatment for familial mediterranean fever in children. Semin Arthritis Rheum 2019; 49:459-463. [PMID: 31255241 DOI: 10.1016/j.semarthrit.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/27/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Colchicine has been found to be highly effective for the treatment of familial Mediterranean fever (FMF). However, it is FDA-approved only for children older than 4 years owing to the lack of studies in younger children. Our tertiary pediatric rheumatology department routinely uses colchicine even in very young children with FMF. The aim of the study was to evaluate its safety and efficacy in children with FMF <4 years old. METHODS The departmental database was searched for all children diagnosed with FMF between 2010-2018. Those who started treatment with colchicine before age 4 years were identified and matched by MEFV variant to children who started treatment at age 4-8 years. Drug efficacy was assessed by the improvement in the frequency and duration of attacks. Adverse events were assessed according to the Rheumatology Common Toxicity Criteria ver. 2.0. RESULTS The cohort included 89 patients with FMF: 41 first treated before age 4 years, and 48 first treated at age 4-8 years. Rates of complete response to colchicine were 61% in the younger group and 60.4% in the older group, Corresponding rates of partial remission were 24.4% and 29.2% (p = 0.77). The most frequent adverse event was diarrhea, with a prevalence of 24.4% in the younger group and22. 9% in the older group respectively (p = 0.87). There were no significant between-group differences in other adverse events. CONCLUSION Colchicine is equally effective and safe for use in patients with FMF under 4 years old, with no difference in response from older pediatric patients.
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Affiliation(s)
- Ori Goldberg
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoel Levinsky
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Orit Peled
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel
| | - Gideon Koren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Medical Informatics, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liora Harel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gil Amarilyo
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
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25
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Gunasekaran K, Mathew DE, Sudarsan TI, Iyyadurai R. Fatal colchicine intoxication by ingestion of Gloriosa superba tubers. BMJ Case Rep 2019; 12:12/5/e228718. [PMID: 31101749 DOI: 10.1136/bcr-2018-228718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gloriosa superba is an ornamental herb, wildly found in the tropics especially in the southern parts of India and Sri Lanka. All parts of the plants are toxic, especially the tuberous rhizomes in view of their high content of colchicines and its derivatives. We report a case of fatal ingestion of the tubers of G. superba, with an intention of deliberate self harm, leading to systemic coagulopathy and progressive multiple organ dysfunctions. The patient was managed with intralipid rescue therapy, plasmapheresis, haemodialysis and intensive care. The ease of availability makes plant poisons, a common method of deliberate self-harm in South India. This report reiterates the need for clinician's awareness of common toxidromes associated with plant poisons.
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Giorgetti A, Nalesso A, Cecchetto G, Pizzi M, Bellan A, Viel G, Montisci M. Two fatal intoxications by colchicine taken for saffron. Clinical, medico-legal and forensic toxicological implications. Leg Med (Tokyo) 2019; 38:64-68. [PMID: 30991227 DOI: 10.1016/j.legalmed.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/11/2019] [Accepted: 04/10/2019] [Indexed: 11/16/2022]
Abstract
Although fatal colchicine intoxications are rare and mostly related to suicidal intake or accidental overdose, other hypotheses should be considered when dealing with colchicine poisoning. We present a case of double, acute, and subacute, fatal colchicine intoxication in a married couple. The 70-year-old male victim suddenly died after vomiting and diarrhea. The next day his wife showed aggravating gastrointestinal symptoms and was hospitalized with a diagnosis of septic shock. A complete postmortem examination on the man was performed, together with histopathological analysis. Toxicological examination performed through liquid chromatography coupled to mass spectrometry revealed a colchicine blood peripheral concentration of 33 ng/mL. A few days after hospitalization, the woman showed a colchicine plasma concentration of 32 ng/mL. Despite veno-venous hemofiltration, she ultimately died of septic shock and multi-organ failure. Death scene investigation revealed that, a few days before the death of the male victim, the couple had collected wild saffron and had eaten a presumed saffron risotto. The integrated analysis of circumstantial, clinical, postmortem and toxicological data allowed to establish that the couple had died of a fatal accidental intoxication due to the ingestion of natural colchicine, mistaken for saffron. The death of the male was deemed caused by acute cardiovascular collapse induced by acute intoxication, while the female had suffered a subacute poisoning by antimitotic agent, resulting in immunosuppression and systemic infection. Toxicological analyses, promptly performed on the man for forensic purposes, directed the investigations and suggested the clinical diagnosis on the woman.
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Affiliation(s)
- Arianna Giorgetti
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Alessandro Nalesso
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Giovanni Cecchetto
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Marco Pizzi
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Alberto Bellan
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Guido Viel
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy.
| | - Massimo Montisci
- Department of Legal and Occupational Medicine, Toxicology and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
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Shchegravina ES, Tretiakova DS, Alekseeva AS, Galimzyanov TR, Utkin YN, Ermakov YA, Svirshchevskaya EV, Negrebetsky VV, Karpechenko NY, Chernikov VP, Onishchenko NR, Vodovozova EL, Fedorov AY, Boldyrev IA. Phospholipidic Colchicinoids as Promising Prodrugs Incorporated into Enzyme-Responsive Liposomes: Chemical, Biophysical, and Enzymological Aspects. Bioconjug Chem 2019; 30:1098-1113. [PMID: 30817133 DOI: 10.1021/acs.bioconjchem.9b00051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Enzyme-responsive liposomes release their cargo in response to pathologically increased levels of enzymes at the target site. We report herein an assembly of phospholipase A2-responsive liposomes based on colchicinoid lipid prodrugs incorporated into lipid bilayer of the nanosized vesicles. The liposomes were constructed to addresses two important issues: (i) the lipid prodrugs were designed to fit the structure of the enzyme binding site; and (ii) the concept of lateral pressure profile was used to design lipid prodrugs that introduce almost no distortions into the lipid bilayer packing, thus ensuring that corresponding liposomes are stable. The colchicinoid agents exhibit antiproliferative activity in subnanomolar range of concentrations.
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Affiliation(s)
- Ekaterina S Shchegravina
- Lobachevsky State University of Niznhy Novgorod , 23 Gagarin Prospest , Nizhny Novgorod , 603950 Russian Federation.,Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Daria S Tretiakova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Anna S Alekseeva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Timur R Galimzyanov
- A. N. Frumkin Institute of Physical Chemistry and Electrochemistry, Russian Academy of Sciences , 31/4 Leninskii Prospekt , Moscow , 119071 Russian Federation.,National University of Science and Technology MISiS , 4 Leninskiy Prospekt , Moscow , 119049 Russian Federation
| | - Yuri N Utkin
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Yuri A Ermakov
- A. N. Frumkin Institute of Physical Chemistry and Electrochemistry, Russian Academy of Sciences , 31/4 Leninskii Prospekt , Moscow , 119071 Russian Federation
| | - Elena V Svirshchevskaya
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Vadim V Negrebetsky
- Pirogov Russian National Research Medical University , 1 Ostrovityanov Street , Moscow , 117997 Russian Federation
| | - Natalia Yu Karpechenko
- N. N. Blokhin National Medical Research Center of Oncology , 24 Kashirskoye Shosse , Moscow , 115478 Russian Federation
| | - Valery P Chernikov
- Scientific Research Institute of Human Morphology , 3 Tsurupa Street , Moscow , 117418 Russian Federation
| | - Natalia R Onishchenko
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Elena L Vodovozova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
| | - Alexey Yu Fedorov
- Lobachevsky State University of Niznhy Novgorod , 23 Gagarin Prospest , Nizhny Novgorod , 603950 Russian Federation
| | - Ivan A Boldyrev
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences , 16/10 Miklukho-Maklaya Street , Moscow , 117997 Russian Federation
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Blackham RE, Little M, Baker S, Augustson BM, MacQuillan GC. Unsuspected Colchicine Overdose in a Female Patient Presenting as an Acute Abdomen. Anaesth Intensive Care 2019; 35:437-9. [PMID: 17591144 DOI: 10.1177/0310057x0703500322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of multi-system organ failure as a result of unsuspected colchicine overdose in a patient with known gout and bulimia nervosa. The patient had initially presented with mild gastrointestinal symptoms with rapid progression to fulminant hepatic failure and multiple organ dysfunction before the causative agent was identified. The patient survived with aggressive intensive care support and ongoing medical treatment. Physicians should be aware of the risk assessment based on the ingested dose, that the clinical presentation of colchicine in toxic doses may be nonspecific with high potential for severe morbidity or death and that survival may occur despite multiple organ failure requiring aggressive support.
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Affiliation(s)
- R E Blackham
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Arbel Y, Abuzeid W, Rosenson RS, Weisman A, Farkouh ME. Old Drugs for New Indications in Cardiovascular Medicine. Cardiovasc Drugs Ther 2019; 32:223-232. [PMID: 29633048 DOI: 10.1007/s10557-018-6785-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Inflammation participates in the initiation and progression of atherosclerotic cardiovascular disease, and it is a critical inciting factor leading to acute ischemic events. Evidence has shown that certain anti-inflammatory medications used to treat non-atherosclerotic inflammatory diseases reduce cardiovascular events. This article reviews evidence that commonly used anti-inflammatory therapies (colchicine, allopurinol, methotrexate), reduce cardiovascular events. We discuss potential mechanisms of action, efficacy, and safety of these therapies and propose a clinical trials design to investigate their efficacy.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Wael Abuzeid
- Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Ontario, Canada, affiliated with the University of Toronto, Toronto, Ontario, Canada
| | - Robert S Rosenson
- Mount Sinai Icahn School of Medicine, Mount Sinai Hospital, New York, USA
| | - Alanna Weisman
- Division of Endocrinology & Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Peter Munk Centre, Heart & Stroke Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada
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Abstract
Colchicine is an alkaloid which was originally extracted from bulbs of a plant called Colchicum autumnale (meadow saffron). Its active pharmacological component was isolated in 1820 and in 1833 the active ingredient was purified and named colchicine. It consists of three hexameric rings termed A, B, and C. It was first recommended for the treatment of gout by Alexander of Tralles in the sixth century AD. Later it has been employed for suggested and approved indications including primary biliary cirrhosis (PBC), alcohol induced hepatitis, psoriasis, Behçet disease, Sweet syndrome, scleroderma, sarcoidosis and amyloidosis. Perhaps the most effective results have been obtained in the prophylaxis of familial Mediterranean fever (FMF). Colchicine is absorbed in the jejunum and ileum and is trapped in the body tissues. It is metabolized in the liver and the intestine by cytochrome P (CYP) 450 3A4 and P-glycoprotein (PGY) 1. Colchicine is excreted mainly by the biliary system, intestines and the kidneys. It has a narrow therapeutic range, but with normal liver and kidney functions is relatively safe and can be used during pregnancy, nursing and in infants. The main mechanism of action of colchicine is probably through interaction with microtubules affecting leukocyte chemotaxis, thereby suppressing inflammation. The blood level of colchicine may be affected by concomitant drug administration and therefore, caution should be exercised when such medications are added.
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Abdulbaqi IM, Darwis Y, Assi RA, Khan NAK. Transethosomal gels as carriers for the transdermal delivery of colchicine: statistical optimization, characterization, and ex vivo evaluation. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:795-813. [PMID: 29670336 PMCID: PMC5898596 DOI: 10.2147/dddt.s158018] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction Colchicine is used for the treatment of gout, pseudo-gout, familial Mediterranean fever, and many other illnesses. Its oral administration is associated with poor bioavailability and severe gastrointestinal side effects. The drug is also known to have a low therapeutic index. Thus to overcome these drawbacks, the transdermal delivery of colchicine was investigated using transethosomal gels as potential carriers. Methods Colchicine-loaded transethosomes (TEs) were prepared by the cold method and statistically optimized using three sets of 24 factorial design experiments. The optimized formulations were incorporated into Carbopol 940® gel base. The prepared colchicine-loaded transethosomal gels were further characterized for vesicular size, dispersity, zeta potential, drug content, pH, viscosity, yield, rheological behavior, and ex vivo skin permeation through Sprague Dawley rats’ back skin. Results The results showed that the colchicine-loaded TEs had aspherical irregular shape, nanometric size range, and high entrapment efficiency. All the formulated gels exhibited non-Newtonian plastic flow without thixotropy. Colchicine-loaded transethosomal gels were able to significantly enhance the skin permeation parameters of the drug in comparison to the non-ethosomal gel. Conclusion These findings suggested that the transethosomal gels are promising carriers for the transdermal delivery of colchicine, providing an alternative route for drug administration.
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Affiliation(s)
- Ibrahim M Abdulbaqi
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - Yusrida Darwis
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - Reem Abou Assi
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
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Martínez GJ, Celermajer DS, Patel S. The NLRP3 inflammasome and the emerging role of colchicine to inhibit atherosclerosis-associated inflammation. Atherosclerosis 2018; 269:262-271. [DOI: 10.1016/j.atherosclerosis.2017.12.027] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 12/22/2022]
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Eddleston M, Fabresse N, Thompson A, Al Abdulla I, Gregson R, King T, Astier A, Baud FJ, Clutton RE, Alvarez JC. Anti-colchicine Fab fragments prevent lethal colchicine toxicity in a porcine model: a pharmacokinetic and clinical study. Clin Toxicol (Phila) 2018; 56:773-781. [PMID: 29334816 PMCID: PMC6021765 DOI: 10.1080/15563650.2017.1422510] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Colchicine poisoning is commonly lethal. Colchicine-specific Fab fragments increase rat urinary colchicine clearance and have been associated with a good outcome in one patient. We aimed to develop a porcine model of colchicine toxicity to study the pharmacokinetics and efficacy of ovine Fab. Methods: A Göttingen minipig critical care model was established and serial blood samples taken for colchicine and Fab pharmacokinetics, clinical chemistry, and haematology. Animals were euthanised when the mean arterial pressure fell below 45 mmHg without response to vasopressor, or at study completion. Results: Initial studies indicated that oral dosing produced variable pharmacokinetics and time-to-euthanasia. By contrast, intravenous infusion of 0.25 mg/kg colchicine over 1 h produced reproducible pharmacokinetics (AUC0–20 343 [SD = 21] µg/L/h), acute multi-organ injury, and cardiotoxicity requiring euthanasia a mean of 22.5 (SD = 3.2) h after dosing. A full-neutralising equimolar Fab dose given 6 h after the infusion (50% first hour, 50% next 6 h [to reduce renal-loss of unbound Fab]) produced a 7.35-fold increase in plasma colchicine (AUC0–20 2,522 [SD = 14] µg/L/h), and removed all free plasma colchicine, but did not prevent toxicity (euthanasia at 29.1 [SD = 3.4] h). Earlier administration over 1 h of the full-neutralising dose, 1 or 3 h after the colchicine, produced a 12.9-fold (AUC0–20 4,433 [SD = 607] µg/L/h) and 6.0-fold (AUC0–20 2,047 [SD = 51] µg/L/h) increase in plasma colchicine, respectively, absence of free plasma colchicine until 20 h, and survival to study end without marked cardiotoxicity. Conclusions: Colchicine-specific Fab given early, in equimolar dose, bound colchicine, eliciting its movement into the blood, and preventing severe toxicity. Clinical studies are now needed to determine how soon this antidote must be given to work in human poisoning.
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Affiliation(s)
- Michael Eddleston
- a Pharmacology, Toxicology, and Therapeutics , University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK.,b Wellcome Trust Critical Care for Large Animals, Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh , Edinburgh , UK
| | - Nicolas Fabresse
- c Laboratoire de Pharmacologie - Toxicologie , Centre Hospitalier Universitaire Raymond Poincaré, AP-HP et MassSpecLab, Plateforme de Spectrométrie de Masse, Inserm U-1173, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin , Garches , France
| | - Adrian Thompson
- a Pharmacology, Toxicology, and Therapeutics , University/BHF Centre for Cardiovascular Science, University of Edinburgh , Edinburgh , UK.,b Wellcome Trust Critical Care for Large Animals, Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh , Edinburgh , UK
| | | | - Rachael Gregson
- b Wellcome Trust Critical Care for Large Animals, Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh , Edinburgh , UK
| | - Tim King
- b Wellcome Trust Critical Care for Large Animals, Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh , Edinburgh , UK
| | | | - Frederic J Baud
- f University Paris Diderot, Assistance Publique - Hopitaux de Paris , Paris , France
| | - R Eddie Clutton
- b Wellcome Trust Critical Care for Large Animals, Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh , Edinburgh , UK
| | - Jean-Claude Alvarez
- c Laboratoire de Pharmacologie - Toxicologie , Centre Hospitalier Universitaire Raymond Poincaré, AP-HP et MassSpecLab, Plateforme de Spectrométrie de Masse, Inserm U-1173, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin , Garches , France
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Liu L, Zhang W, Li L, Zhu X, Liu J, Wang X, Song Z, Xu H, Wang Z. Biomechanical measurement and analysis of colchicine-induced effects on cells by nanoindentation using an atomic force microscope. J Biomech 2017; 67:84-90. [PMID: 29249455 DOI: 10.1016/j.jbiomech.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022]
Abstract
Colchicine is a drug commonly used for the treatment of gout, however, patients may sometimes encounter side-effects induced by taking colchicine, such as nausea, vomiting, diarrhea and kidney failure. In this regard, it is imperative to investigate the mechanism effects of colchicine on biological cells. In this paper, we present a method for the detection of mechanical properties of nephrocytes (VERO cells), hepatocytes (HL-7702 cells) and hepatoma cells (SMCC-7721 cells) in culture by atomic force microscope (AFM) to analyze the 0.1 μg/mL colchicine-induced effects on the nanoscale for two, four and six hours. Compared to the corresponding control cells, the biomechanical properties of the VERO and SMCC-7721 cells changed significantly and the HL-7702 cells did not considerably change after the treatment when considering the same time period. Based on biomechanical property analyses, the colchicine solution made the VERO and SMCC-7721 cells harder. We conclude that it is possible to reduce the division rate of the VERO cells and inhibit the metastasis of the SMCC-7721 cells. The method described here can be applied to study biomechanics of many other types of cells with different drugs. Therefore, this work provides an accurate and rapid method for drug screening and mechanical analysis of cells in medical research.
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Affiliation(s)
- Lanjiao Liu
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China
| | - Wenxiao Zhang
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China
| | - Li Li
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China
| | - Xinyao Zhu
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK
| | - Jinyun Liu
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China; Joint Research Centre for Computer-Controlled Nanomanufacturing, University of Bedfordshire, Luton LU1 3JU, UK
| | - Xinyue Wang
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China
| | - Zhengxun Song
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China
| | - Hongmei Xu
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China
| | - Zuobin Wang
- International Research Centre for Nano Handling and Manufacturing of China, Changchun University of Science and Technology, Changchun 130022, China; Joint Research Centre for Computer-Controlled Nanomanufacturing, University of Bedfordshire, Luton LU1 3JU, UK.
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Paymode D, Ramana CV. Total Synthesis of (±)-Allocolchicine and Its Analogues Using Co-Catalyzed Alkyne [2 + 2 + 2]-Cyclotrimerization. ACS OMEGA 2017; 2:5591-5600. [PMID: 31457824 PMCID: PMC6644368 DOI: 10.1021/acsomega.7b00980] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/24/2017] [Indexed: 06/10/2023]
Abstract
The total synthesis of (±)-allocolchicine has been completed by employing cobalt-catalyzed alkyne [2 + 2 + 2]-cyclotrimerization as the key reaction. The essential diyne has been synthesized from easily available 3,4,5-trimethoxybenzaldehyde following simple chemical transformations. In general, the cycloaddition gave a mixture of C(9) and C(10) isomers thus allowing the synthesis of both allocolchicine and its C(10)-carboxylate. Because this cycloaddition was employed at the penultimate stage, it allowed the synthesis of various analogues having the diverse functionality at C(9) and/or C(10) of ring C.
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Affiliation(s)
- Dinesh
J. Paymode
- Division
of Organic Chemistry, CSIR-National Chemical
Laboratory, Dr. Homi Bhabha Road, Pune 411008, Maharashtra, India
- Academy
of Scientific and Innovative Research (AcSIR), New Delhi 110020, India
| | - Chepuri V. Ramana
- Division
of Organic Chemistry, CSIR-National Chemical
Laboratory, Dr. Homi Bhabha Road, Pune 411008, Maharashtra, India
- Academy
of Scientific and Innovative Research (AcSIR), New Delhi 110020, India
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Colchicine-Induced Myopathy in a Tacrolimus-Treated Renal Transplant Recipient: Case Report and Literature Review. Am J Ther 2016; 23:e614-6. [PMID: 24732905 DOI: 10.1097/mjt.0000000000000044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal transplant recipients are prone to develop drug toxicities because of polypharmacy and drug-drug interactions. Colchicine is often used for the treatment of gout in these patients as nonsteroidal medications are contraindicated. In addition, patients are often on corticosteroids and frequent, periodic, dose escalation for gouty flare may lead to side effects. Colchicine-induced myopathy has been very well described in the literature. Several cases of colchicine toxicity have been reported in cyclosporine-treated patients due to a drug-drug interaction. We report a 62-year-old African American renal transplant recipient who had been doing well on tacrolimus-based immunosuppression and was started on colchicine (0.6 mg twice daily) for gouty flare. A few days later, he was found to have a 4-fold increase in aspartate aminotransferase and an elevated creatine phosphokinase. Although this interaction is very well known with cyclosporine, it has not yet been reported in patients on tacrolimus.
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McAlister A, Center SA, Bender H, McDonough SP. Adverse interaction between colchicine and ketoconazole in a Chinese shar pei. J Am Anim Hosp Assoc 2016; 50:417-23. [PMID: 25379734 DOI: 10.5326/jaaha-ms-6080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A Chinese shar pei with a 2 yr history of episodic fever, lethargy, and shifting lameness was presumptively diagnosed with familial shar pei fever but had never been treated for the syndrome. After being presented for a superficial pyoderma with possible dermatophyte coinfection, treatment with a cephalosporin and ketoconazole were prescribed. One wk later, colchicine was initiated for familial shar pei fever using cautious dose escalation. Nevertheless, gastrointestinal toxicity, skeletal muscle myopathy, and hepatotoxicity developed within 2 wk. Abrupt resolution of gastrointestinal toxicity and myopathy followed drug withdrawal. However, escalating liver enzyme activity and hyperbilirubinemia led to liver biopsy to rule out an antecedent hepatopathy. Biopsy characterized canalicular cholestasis and colchicine-associated metaphase arrest and ring mitoses reflecting repression of mitotic spindle formation. Signs of illness completely resolved 3 mo after drug discontinuation. Although avoidable adverse interactions between ketoconazole and drugs reliant on cytochrome oxidase biotransformation and/or drug efflux mediated by multiple drug-resistant transporters are well documented in humans, these are rarely reported in veterinary patients. This case exemplifies an important and avoidable ketoconazole/colchicine drug interaction from which the patient completely recovered. The dog tested negative for the canine MDR1 loss of function mutation that also might potentiate colchicine toxicity.
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Affiliation(s)
- Amber McAlister
- Sage Veterinary Specialty and Emergency Centers in Campbell, CA (A.M.); Department of Clinical Sciences (S.C., S.M.) and Department of Biomedical Sciences (H.B.), College of Veterinary Medicine, Cornell University, Ithaca, NY
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Ataş B, Caksen H, Tuncer O, Kirimi E, Akgün C, Odabaş D. Four children with colchicine poisoning. Hum Exp Toxicol 2016; 23:353-6. [PMID: 15311853 DOI: 10.1191/0960327104ht457sc] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Colchicine poisoning is a rare event. It is characterized by multiorgan involvement and by poor prognosis associated with overdose. In this article we present four children with colchicine poisoning to emphasize that colchicine poisoning has a large spectrum in childhood. The children's ages ranged between 1 year and 3.5 years. The ingested dosage of colchicine was between 0.37 and 1.72 mg/kg. Most of the findings of colchicine poisoning such as gastrointestinal symptoms, hepatotoxicity, cardiotoxicity, bone marrow suppression, hypocalcaemia and hair loss were diagnosed in our patients. Two children receiving 0.37 mg/kg and 1 mg/kg colchicine and admitted 13 and 19 hours after poisoning, respectively, died. Our findings suggest that in addition to amounts of the drug, mortality was also related to the duration between drug ingestion and admission to hospital.
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Affiliation(s)
- Bülent Ataş
- Department of Pediatrics, Faculty of Medicine, Yüzüncü Yil University, Van, Turkey.
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van der Hilst JC, Moutschen M, Messiaen PE, Lauwerys BR, Vanderschueren S. Efficacy of anti-IL-1 treatment in familial Mediterranean fever: a systematic review of the literature. Biologics 2016; 10:75-80. [PMID: 27110096 PMCID: PMC4831592 DOI: 10.2147/btt.s102954] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction In 5%–10% of patients with familial Mediterranean fever (FMF), colchicine is not effective in preventing inflammatory attacks. Another 5%–10% of patients are intolerant to effective doses of colchicine and experience serious side effects. Treatment with anti-interleukin-1 (IL-1) drugs may be an alternative for these patients, although it is not reimbursed for this indication in many countries. Methods We systematically searched PubMed, Web of Science, and Scopus for reports of anti-IL-1 treatment in FMF patients. Results Out of 284 potentially relevant articles, 27 eligible reports were identified and included in the data analysis. Conclusion A complete response to therapy without a single attack during treatment was reported in 76.5% of patients on anakinra treatment and in 67.5% of patients during canakinumab treatment. In patients with established type AA amyloidosis, anti-IL-1 treatment can reverse proteinuria. Anti-IL-1 therapy seems to be a safe and effective alternative for patients with FMF who do not respond to or cannot tolerate colchicine.
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Affiliation(s)
- Jeroen Ch van der Hilst
- Department of Infectious diseases and Immunity, Jessa Hospital, Hasselt, Belgium; Biomedical Research Institute, University of Hasselt, Hasselt, Belgium
| | - Michel Moutschen
- Department of Immunity and Infectious Diseases, University Hospital of Liège, Liège, Belgium
| | - Peter E Messiaen
- Department of Infectious diseases and Immunity, Jessa Hospital, Hasselt, Belgium; Biomedical Research Institute, University of Hasselt, Hasselt, Belgium
| | - Bernard R Lauwerys
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Steven Vanderschueren
- KU Leuven, Laboratory of Clinical Infectious and Inflammatory Disorders, University Hospitals Leuven, Leuven, Belgium
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Abstract
AIM The aim of the study is to discuss clinical effects, treatments, and outcomes of pediatric colchicine poisoning. METHOD This study was designed as an observational case series study. The medical records of children aged between 0 and 18 years, who were hospitalized for colchicine poisoning at the Department of Pediatric Intensive Care Unit, Cumhuriyet University Faculty of Medicine, between January 2010 and January 2012, were retrospectively evaluated. RESULTS We presented 17 children with colchicine poisoning. The mean (SD, range) age of patients was 71.5 (69.19, 18-204) months. The period to apply to the hospital after taking the medications was 7.3 hours (7.97, 30 minutes-26 hours) on average. The use of colchicine was due to diagnosis of Familial Mediterranean fever (FMF) in the families of 8 patients, diagnosis of Behçet disease in 1 patient's father, diagnosis of Behçet disease in 1 patient herself, and diagnosis of FMF in 6 patients themselves. Thirteen patients had taken colchicine at the dose of less than 0.5 mg/kg known as subtoxic and 1 patient had taken colchicine at the dose of greater than 0.8 mg/kg, and doses taken by 3 patients were not known. Fourteen patients (82.4%) had involuntary drug intake. Fifty percent of them were symptomatic at the moment of application and all had gastrointestinal complaints. All patients were observed in intensive care unit upon first admission and received supportive care. One of patients showed total alopecia, one showed leucocytosis, and another one showed acute abdomen picture. None of the patients showed mortality. CONCLUSIONS Mortality of colchicine toxicity is high and quick assessment is absolutely required. In regions where FMF is common and the use of colchicine is high, clinicians should pay attention to symptoms and findings related to colchicine intoxication and keep them in mind in differential diagnosis.
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Ozen S, Demirkaya E, Erer B, Livneh A, Ben-Chetrit E, Giancane G, Ozdogan H, Abu I, Gattorno M, Hawkins PN, Yuce S, Kallinich T, Bilginer Y, Kastner D, Carmona L. EULAR recommendations for the management of familial Mediterranean fever. Ann Rheum Dis 2016; 75:644-51. [DOI: 10.1136/annrheumdis-2015-208690] [Citation(s) in RCA: 290] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/03/2016] [Indexed: 01/23/2023]
Abstract
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease, but many rheumatologists are not well acquainted with its management. The objective of this report is to produce evidence-based recommendations to guide rheumatologists and other health professionals in the treatment and follow-up of patients with FMF. A multidisciplinary panel, including rheumatologists, internists, paediatricians, a nurse, a methodologist and a patient representative, was assembled. Panellists came from the Eastern Mediterranean area, Europe and North America. A preliminary systematic literature search on the pharmacological treatment of FMF was performed following which the expert group convened to define aims, scope and users of the guidelines and established the need for additional reviews on controversial topics. In a second meeting, recommendations were discussed and refined in light of available evidence. Finally, agreement with the recommendations was obtained from a larger group of experts through a Delphi survey. The level of evidence (LoE) and grade of recommendation (GR) were then incorporated. The final document comprises 18 recommendations, each presented with its degree of agreement (0–10), LoE, GR and rationale. The degree of agreement was greater than 7/10 in all instances. The more controversial statements were those related to follow-up and dose change, for which supporting evidence is limited. A set of widely accepted recommendations for the treatment and monitoring of FMF is presented, supported by the best available evidence and expert opinion. It is believed that these recommendations will be useful in guiding physicians in the care of patients with FMF.
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Little A, Tung D, Truong C, Lapinsky S, Burry L. Colchicine overdose with coingestion of nonsteroidal antiinflammatory drugs. CAN J EMERG MED 2015; 16:252-6. [DOI: 10.2310/8000.2013.130957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Colchicine has a low therapeutic index. Its toxic effects generally occur at doses ≥ 0.5 mg/kg. We present the case of a 39-year-old female with toxicity following ingestion of 0.28 mg/kg. The patient presented to the emergency department (ED) with severe nausea, vomiting, and abdominal pain following an intentional multidrug ingestion that included colchicine, indomethacin, and zopiclone. Despite toxicologic management and supportive care, admission to the intensive care unit was required for clinical deterioration and symptom management. Shock and multiorgan failure resulted, with death occurring 52 hours postingestion. Although the toxic effects of colchicine are well documented, mortality caused by low doses is relatively uncommon. Management of toxicity consists of early diagnosis, decontamination, and supportive measures. Toxicity may be enhanced by drug interactions inhibiting metabolic enzymes or poor excretion due to renal failure. In this case, the ingestion of a nonsteroidal antiinflammatory drug and the associated volume depletion from the gastrointestinal effects of colchicine may have contributed to renal dysfunction, exacerbating the toxicity of colchicine. This ingestion of a relatively small dose of colchicine led to severe toxicity. Treatment options for colchicine toxicity are limited.
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Sitnikov NS, Sinzov AV, Allegro D, Barbier P, Combes S, Onambele LA, Prokop A, Schmalz HG, Fedorov AY. Synthesis of indole-derived allocolchicine congeners exhibiting pronounced anti-proliferative and apoptosis-inducing properties. MEDCHEMCOMM 2015. [DOI: 10.1039/c5md00320b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The synthesis and biological assessment of indole-based allocolchicine congeners with potent anti-proliferative and apoptosis-inducing activity are reported.
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Affiliation(s)
- Nikolay S. Sitnikov
- Department of Organic Chemistry
- Lobachevsky State University of Nizhni Novgorod
- Nizhni Novgorod 603950
- Russia
- Department für Chemie
| | - Alexander V. Sinzov
- Department of Organic Chemistry
- Lobachevsky State University of Nizhni Novgorod
- Nizhni Novgorod 603950
- Russia
| | | | | | - Sebastien Combes
- Laboratory of Integrative Structural and Chemical Biology, Institut Paoli-Calmettes
- Aix-Marseille Université
- Marseille
- France
| | | | - Aram Prokop
- Department of Pediatric Hematology/Oncology
- 50735 Köln
- Germany
| | | | - Alexey Yu. Fedorov
- Department of Organic Chemistry
- Lobachevsky State University of Nizhni Novgorod
- Nizhni Novgorod 603950
- Russia
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Kurt RK, Dogan AC, Dogan M, Albayrak A, Kurt SN, Eren F, Okyay AG, Karateke A, Duru M, Fadillioglu E, Delibasi T. Protective Effect of Colchicine on Ovarian Ischemia–Reperfusion Injury. Reprod Sci 2014; 22:545-50. [DOI: 10.1177/1933719114553065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Raziye Keskin Kurt
- Mustafa Kemal University Medical School, Department of Obstetrics and Gynecology, Hatay, Turkey
| | - Ayse Citil Dogan
- Zekai Tahir Burak Women’s Health Training and Research Hospital, Ankara, Turkey
| | - Murat Dogan
- Hacettepe University Medical School, Department of Physiology, Ankara, Turkey
| | - Aynur Albayrak
- Ankara Diskapi YB Training and Research Hospital, Department of Pathology, Ankara, Turkey
| | - Sefika Nur Kurt
- Hacettepe University Medical School, Department of Physiology, Ankara, Turkey
| | - Furkan Eren
- Hacettepe University Medical School, Department of Physiology, Ankara, Turkey
| | - Ayse Guler Okyay
- Mustafa Kemal University Medical School, Department of Obstetrics and Gynecology, Hatay, Turkey
| | - Atilla Karateke
- Mustafa Kemal University Medical School, Department of Obstetrics and Gynecology, Hatay, Turkey
| | - Mehmet Duru
- Mustafa Kemal University Medical School, Department of Emergency Medicine, Hatay, Turkey
| | - Ersin Fadillioglu
- Hacettepe University Medical School, Department of Physiology, Ankara, Turkey
| | - Tuncay Delibasi
- Ankara Diskapi YB Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
- Ankara Diskapi YB Training and Research Hospital, Pancreas Islet Research Center, Ankara, Turkey
- Hacettepe University Kastamonu Medical School, Department of Endocrinology and Metabolism, Ankara, Turkey
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Sitnikov NS, Kokisheva AS, Fukin GK, Neudörfl JM, Sutorius H, Prokop A, Fokin VV, Schmalz HG, Fedorov AY. Synthesis of Indole-Derived Allocolchicine Congeners through Pd-Catalyzed Intramolecular C-H Arylation Reaction. European J Org Chem 2014. [DOI: 10.1002/ejoc.201402850] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bitik B, Öztürk MA. An old disease with new insights: Update on diagnosis and treatment of gout. Eur J Rheumatol 2014; 1:72-77. [PMID: 27708879 DOI: 10.5152/eurjrheumatol.2014.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/21/2014] [Indexed: 12/20/2022] Open
Abstract
Gout is an acute and chronic inflammatory disorder associated with high morbidity and impaired quality of life. There has been a substantial increase in the prevalence and incidence of gout in recent years. Novel diagnostic and therapeutic options have provided new insights into the pathogenesis and management of hyperuricemia and gout in the last decade. This clinical review aims to summarize the diagnostic process and management of acute and chronic gout.
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Affiliation(s)
- Berivan Bitik
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - M Akif Öztürk
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Huang B, Giannini EH, Lovell DJ, Ding L, Liu Y, Hashkes PJ. Enhancing crossover trial design for rare diseases: limiting ineffective exposure and increasing study power by enabling patient choice to escape early. Contemp Clin Trials 2014; 38:204-12. [PMID: 24833067 DOI: 10.1016/j.cct.2014.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/25/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Addressing the two most important considerations in designing clinical trials, i.e. maximizing study power and minimizing patient exposure to ineffective treatment, is particularly challenging for trials of rare diseases. The familial Mediterranean fever (FMF) rilonacept trial (Hashkes et al., Ann Intern Med 2012;157:533-41) demonstrates a novel crossover design by enabling patient choice to early escape for rare disease. PURPOSE To investigate the effect on study power, exposure to the ineffective treatment arm and dropout rate by implementing early escape to crossover design, and to propose a Bayesian modeling approach. METHOD Based on the FMF trial data, simulation studies compared study power and dropout rate among three types of designs for crossover trial: traditional without early escape, early escape per-patient-choice, and early escape per-protocol. RESULTS The early escape per patient choice or per protocol design achieved 0.89 ± 0.12 and 0.78 ± 0.20 of the study efficiency when compared to the traditional crossover design assuming no dropout. Early escape per patient choice compared to early escape per protocol improved power by 1.29 ± 0.26, and reduced the dropout rate by 8-29%, but with greater patient exposure to the less effective treatment arm. CONCLUSIONS The results of the FMF trial and simulation studies suggest that allowing early escape in crossover trial enhanced the design by minimizing patient's exposure to the ineffective treatment arm while maintaining a reasonable study power, which is particularly important for rare disease trials. Choice between the two types of early escape presents tradeoff between study power and exposure to ineffective treatment.
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Affiliation(s)
- Bin Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Edward H Giannini
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Lili Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Yongchao Liu
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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