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BMC Cardiovasc Disord. 2015 Aug 29;15:96. doi: 10.1186/s12872-015-0068-3.

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

Verma S1,2,3, Eikelboom JW4, Nidorf SM5, Al-Omran M6,7,8, Gupta N9, Teoh H10,11,12,13, Friedrich JO14,15,16.

Author information

1
Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. vermasu@smh.ca.
2
Department of Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. vermasu@smh.ca.
3
Department of Surgery, University of Toronto, Toronto, ON, Canada. vermasu@smh.ca.
4
Department of Medicine, McMaster University, Hamilton, ON, Canada. eikelbj@mcmaster.ca.
5
Heart Research Institute, Perth, WA, Australia. smnidorf@gmail.com.
6
Division of Vascular Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. alomranm@smh.ca.
7
Department of Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. alomranm@smh.ca.
8
Department of Surgery, University of Toronto, Toronto, ON, Canada. alomranm@smh.ca.
9
Department of Medicine, McMaster University, Hamilton, ON, Canada. nandini.gupta@medportal.ca.
10
Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.
11
Division of Endocrinology & Metabolism, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.
12
Department of Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.
13
Department of Medicine, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. teohh@smh.ca.
14
Department of Medicine, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. FriedrichJ@smh.ca.
15
Department of Critical Care, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. FriedrichJ@smh.ca.
16
Department of Medicine and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. FriedrichJ@smh.ca.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
26318871
PMCID:
PMC4553011
DOI:
10.1186/s12872-015-0068-3
[Indexed for MEDLINE]
Free PMC Article

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