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Abstract Number: 47

The Risk of Aplastic Anemia and Pancytopenia with Colchicine: A Retrospective Study of Integrated Health System Database

Jasvinder A. Singh1, Shuo Yang2 and Jeff Foster3, 1University of Alabama at Birmingham, Birmingham, AL, 2Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 3The University of Alabama at Birmingham, Birmingham, AL

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Colchicine

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Session Information

Title: Epidemiology and Public Health: Osteoporosis, Non-Inflammatory Arthritis and More

Session Type: Abstract Submissions (ACR)

Background/Purpose Colchicine is a commonly used medication, sometime associated with bone marrow toxicity.  The objective of this study was to examine the risk of severe hematologic side effects including pancytopenia and aplastic anemia with colchicine.

Methods This retrospective study utilized the Veterans Affairs (VA) administrative and clinical databases from fiscal year 2001 to 2012.  Colchicine use was defined as at least 30-day filled prescription.  Prevalent gout was defined as the presence of >=1 International classification of diseases, ninth revision (ICD-9) codes for gout during an inpatient visit or during ³2 codes during outpatient visits.  Aplastic anemia was captured with an ICD-9 code of 284.9 and Pancytopenia with a code of 284.1. We used Cox proportional hazards models that assessed hazards of aplastic anemia or pancytopenia adjusted for the following factors: Model 1:  drug exposure, age, gender, body mass index, race, marital status, region; Model 2: variables in model 1, plus baseline Charlson comorbidities.

Results 198 gout patients had aplastic anemia, of which 59 occurred in patients exposed to colchicine.  2047 gout patients had pancytopenia, of which 582 occurred in patients exposed to colchicine.  The incidence rate of aplastic anemia was 0.5/1000 person years and of pancytopenia was xx/ in patients taking colchicine.

Conclusion Colchicine increases the risk of aplastic anemia 3-4 fold and pancytopenia 2-3 fold in gout patients.  Predictive models that can identify coexisting conditions that increase the risk of these side effects need to be developed to screen out patients at high-risk of these severe hematologic side effects.

 

Table 1. Association of colchicine with severe hematologic side effects

 

Model 1 (demographics)

 

Model 2 (demographics + comorbidity)

 

 

Hazard ratio (95% CI)

p-value

Hazard ratio (95% CI)

p-value

 

 

 

 

 

Aplastic anemia

3.72 (2.61, 5.31)

<0.0001

3.32 (2.32, 4.76)

<0.0001

Pancytopenia

2.88 (2.58, 3.22)

<0.0001

2.26 (2.02, 2.53)

<0.0001

 

 

 

 

 

 

 

 

 

 


Disclosure:

J. A. Singh,

Savient,

2,

Takeda,

2,

Degeneron,

5,

Allergan ,

5;

S. Yang,
None;

J. Foster,
None.

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