September 12th, 2013
Colchicine Found Effective in Acute Pericarditis
Although colchicine has been shown to be beneficial in patients with recurrent pericarditis, which is thought to have a large inflammatory component related to an immune response, until now its efficacy in a first episode of acute pericarditis has been uncertain, as these episodes are thought to usually have a viral component that might benefit from an inflammatory response.
In a study published in the New England Journal of Medicine, 240 patients with acute pericarditis and receiving conventional therapy with aspirin or ibuprofen were randomized to colchicine or placebo for 3 months. Colchicine was found effective in reducing the rate of incessant or recurrent pericarditis (the primary outcome of the trial), as well as symptom recurrence at 72 hours, the number of recurrences per patient, and the rate of hospitalization:
- Incessant or recurrent pericarditis: 16.7% in the colchicine group versus 37.5% in the control group (relative risk reduction, 0.56; CI 0.30-0.72; number needed to treat, 4; p < 0.001)
- Symptom persistence at 72 hours: 19.2% vs. 40.0% (p = 0.001)
- Recurrences per patient: 0.21 vs. 0.52, (p=0.001)
- Hospitalization rate: 5.0% vs. 14.2% (p=0.02)
There were no significant differences in adverse effects or discontinuation of the study drugs.
Results of the study confirm current European guidelines, which give a class IIa indication for the use of colchicine in acute pericarditis, and an earlier, single-center, open-label trial. The precise mechanism of action of colchicine is uncertain, though the authors point to its high concentration in leukocytes. They conclude that “colchicine, when added to conventional antiinflammatory therapy, significantly reduced the rate of incessant or recurrent pericarditis” in patients with a first episode of acute pericarditis.
In a recent case history published in CardioExchange, the use of colchicine was discussed at some length by a number of well-known clinicians, including James Fang, James de Lemos, Kamalendu Kanu Chatterjee, Thomas Ryan, and Rick Akira Nishimura.