BACKGROUND AND AIMS: Randomized trials of colchicine in secondary prevention of atherosclerotic cardiovascular disease have shown mixed results.
METHODS: A systematic review and study-level meta-analysis of randomized controlled trials was performed comparing colchicine vs no colchicine in a secondary-prevention atherosclerotic cardiovascular disease population. A fixed-effect inverse variance model was applied using the intention-to-treat population from the included trials. The primary outcome was the composite of cardiovascular death, myocardial infarction, or stroke.
RESULTS: Nine trials, including 30 659 patients (colchicine 15 255, no colchicine 15 404) with known coronary artery disease or stroke, were included. Compared with no colchicine, patients randomized to colchicine had a relative risk (RR) of 0.88 [95% confidence interval (CI) 0.81-0.95, P = .002] for the primary composite outcome, including a RR of 0.94 for cardiovascular death (95% CI 0.78-1.13, P = .5), a RR of 0.84 for myocardial infarction (95% CI 0.73-0.97, P = .016), and a RR of 0.90 for stroke (95% CI 0.80-1.02, P = .09). Colchicine was associated with a RR of 1.35 for hospitalization for gastrointestinal events (95% CI 1.10-1.66, P = .004) with no increase in hospitalization for pneumonia, newly diagnosed cancers, or non-cardiovascular death.
CONCLUSIONS: In patients with prior coronary disease or stroke, colchicine reduced the composite of cardiovascular death, myocardial infarction, or stroke by 12%.
| Discipline Area | Score |
|---|---|
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Cardiology |  |
| Internal Medicine | |
Good to have a compilation of trials, each of which reported slightly different findings. It's also helpful that all trials in the analysis eventually used 0.5 mg daily, not the US dose usually used. This provides quantification of the GI distress essential in shared decision-making.
This is a very useful systematic review of colchicine in the secondary prevention of vascular events, mostly because it also includes the absolute risks and harms from gastrointestinal side effects. The picture when viewed from this lens is less clear: ARR for a combined endpoint is 0.88% and for ARI for hospitalization from GI events is .55%. Side effects that don't require hospitalization aren't included in this figure. This is the type of study that allows us to have more useful shared decisions with patients.
Colchicine showed a modest benefit in myocardial infarction, but was not significant in cardiovascular death or stroke. Colchicine also increased the side effects requiring hospitalization. So, the decision to prescribe colchicine should not be taken lightly. This raises doubts about its usefulness in this context.
This study showed clear results regarding the usefulness of colchicine for secondary prevention of cardiovascular endpoints.
