An Evaluation of Colchicine as an Alternative to Inhaled Corticosteriods in Moderate Asthma

Abstract

Colchicine demonstrates an array of anti-inflammatory properties of potential relevance to asthma. However, the efficacy of colchicine as an alternative to inhaled corticosteroid therapy for asthma is unknown. Five centers participated in a controlled trial testing the hypothesis that in patients with moderate asthma needing inhaled corticosteroids for control, colchicine provides therapeutic benefit as measured by maintenance of control when inhaled steroids are discontinued. Subjects were stabilized on triamcinolane acetonide (800 microg daily) and then enrolled in a 2-wk run-in during which all subjects took both colchicine (0.6 mg/twice a day) and triamcinolone. At the end of the run-in, all subjects discontinued triamcinolone and were randomized to continued colchicine (n = 35) or placebo (n = 36) for a 6-wk double-blind treatment period. The treatment groups were similar in terms of disease severity. After corticosteroid withdrawal, 60% of colchicine-treated and 56% of placebo-treated subjects were considered treatment failures as defined by preset criteria. No significant difference in survival curves was found between treatment groups (log rank = 0.38). Other measures, including changes in FEV1, peak expiratory flow, symptoms, rescue albuterol use, and quality of life scores, also did not differ between groups. Of note, subjects failing treatment had significantly greater methacholine responsiveness at baseline than did survivors (PC20, 0.81+/-1.38 versus 2.11+/-2.74 mg/ml; p = 0.01). An analysis of treatment failures suggested that the criteria selected for failure reflected a clinically meaningful but safe level of deterioration. We conclude that colchicine is no better than placebo as an alternative to inhaled corticosteroids in patients with moderate asthma. Additionally, we conclude that the use of treatment failure as the primary outcome variable in an asthma clinical trial where treatment is withdrawn is feasible and safe under carefully monitored conditions.

Decreased prevalence of atopy in paediatric patients with familial Mediterranean fever

“…Although the prevalence of asthma is not significantly different in patients with FMF, we can say that previous studies concluded that colchicine had no treatment effect on asthma. 18 Because colchicine does not have an antiallergic action we do not believe that the decreased atopic sensitisation was due to the treatment. The presented results show that personal atopy in the patients and allergic diseases in the parents, who were accepted as obligate carriers, were indeed lower.…”

Colchicine Decreases Airway Hyperreactivity Afrer Phosgene Exposure

“…Colchicine (0.5 mg twice daily) reduced clinical score in 10 asthmatic patients, can partially inhibit immunoglobulin E (IgE)-mediated early and late airway responses (Schwarz et al, 1990), and incidence of asthma was significantly lower in patients with familial Mediterranean fever relative to an age-matched adolescent population (Adaliogul et al, 1994), suggesting a therapeutic potential. However, in a larger definitive study, colchicine was demonstrated to have no effect on moderate asthma (Fish et al, 1997).…”

Les récepteurs du goût dans le poumon : intéressants ou anecdotiques ?

“…Les résultats d'une étude avec un antihistaminique H 1 , la chlorphéniramine, également agoniste des récepteurs TAS2R (dont les sous-types 10 et 14) [9] sont aussi évocateurs de propriétés bronchodilatatrices de cette molé-cule [39]. En revanche, une autre étude dont l'objectif était d'évaluer si la colchicine (agoniste TAS2R4, 39 et 46) pouvait être une alternative aux corticostéroïdes n'a pas montré d'effet bronchodilatateur, vraisemblablement en raison de la faible dose administrée (0,6 mg × 2) liée à la toxicité intrinsèque de la molécule et ne permettant pas l'obtention de concentrations suffisantes au niveau du site d'action [40].…”