Colchicine in cardiac disease: a systematic review and meta-analysis of randomized controlled trials

• Published in: BMC cardiovascular disorders Vol. 15; no. 1; p. 96
• Main Authors: Verma, Subodh, Eikelboom, John W, Nidorf, Stefan M, Al-Omran, Mohammed, Gupta, Nandini, Teoh, Hwee, Friedrich, Jan O
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.08.2015; BioMed Central
• Subjects: Analysis; Care and treatment; Colchicine - therapeutic use; Complications and side effects; Coronary heart disease; Disease susceptibility; Health aspects; Heart Diseases - diagnosis; Heart Diseases - drug therapy; Heart Diseases - epidemiology; Humans; Prevention; Randomized Controlled Trials as Topic - methods
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-015-0068-3

Colchicine has unique anti-inflammatory properties that may be beneficial in various cardiovascular conditions. This systematic review and meta-analysis of randomized controlled trials (RCTs) examines this issue. We searched MEDLINE, EMBASE, and the Cochrane Database from inception to June 2014 for RCTs using colchicine in adult patients with cardiac diseases. Results were pooled using random effects. 15 RCTs (n = 3431 patients, median treatment 3 and follow-up 15 months) were included. All but 2 used colchicine 1 mg/day. In 5 trials, n = 1301) at risk for cardiovascular disease (coronary artery disease, acute coronary syndrome or stroke, post-angioplasty [2 RCTs], or congestive heart failure), colchicine reduced composite cardiovascular outcomes by ~60 % (risk ratio [RR] 0.44, 95 % confidence interval [CI] 0.28-0.69, p = 0.0004; I(2) = 0 %) and showed a trend towards lower all-cause mortality (RR 0.50, 95 % CI 0.23-1.08, p = 0.08; I(2) = 0 %). In pericarditis or post-cardiotomy, colchicine decreased recurrent pericarditis or post-pericardiotomy syndrome (RR 0.50, 95 % CI 0.41-0.60, p < 0.0001; I(2) = 0 %; 8 RCTs, n = 1635), and post-pericardiotomy or ablation induced atrial fibrillation (RR 0.65, 95 % CI 0.51-0.82, p = 0.0003; I(2) = 31 %; 4 RCTs, n = 1118). The most common adverse event was diarrhea. Treatment discontinuation overall and due to adverse events (RR 4.34, 95 % CI 1.70-11.07, p = 0.002; I(2) = 29 %; 7 RCTs, 83/790 [10.5 %] vs. 11/697 [1.6 %]) was higher in colchicine-assigned patients. Current RCT data suggests that colchicine may reduce the composite rate of cardiovascular adverse outcomes in a range of patients with established cardiovascular disease. Furthermore, colchicine reduces rates of recurrent pericarditis, post-pericardiotomy syndrome, and peri-procedural atrial fibrillation following cardiac surgery. Further RCTs evaluating the potential of colchicine for secondary prevention of cardiovascular events would be of interest.