COLCHICINE AND NEW MANAGEMENT STRATEGIES FOR ACUTE AND RECURRENT PERICARDITIS
Massimo Imazio, M.D., Maria Vittoria Hospital, Torino, Italy
Background. Disease recurrence is the major and most common complication of pericarditis and its prevention may reduce morbidity and management costs. Colchicine has been intensively studied in the last decade for pericarditis prevention.
Methods. Controlled clinical studies were searched in several databases and were included provided they focused on the pharmacologic primary or secondary prevention of pericarditis. We performed a meta-analysis including studies primary outcome, adverse events, and drug withdrawal.
Results. From the initial sample of 175 citations, 7 controlled clinical trials were finally included (1275 patients): 5 studies were double- blind randomised controlled trials (RCT), and 2 studies were open-label RCTs. Trials followed patients for a mean of 19 months. Meta-analytic pooling showed that colchicine use was associated with a reduced risk of pericarditis during follow-up (OR=0.33 [0.25-0.44], p for effect< 0.001, p for heterogeneity=0.98, I2=0%) either for primary or secondary prevention without a significant higher risk of adverse events (OR=1.28 [0.84-1.93], p for effect= 0.25, p for heterogeneity=0.72, I2=0%), and drug withdrawals compared with placebo (OR=1.54 [0.98-2.41], p for effect=0.06, p for heterogeneity=0.54, I2=0%). Gastrointestinal intolerance is the most frequent side effect (mean incidence 8%), but no severe adverse events were recorded.
Conclusions. Colchicine is safe and efficacious for the primary and secondary prevention of pericarditis without a significant increase of the risk of side effects and drug withdrawals. At present colchicine is the only drug that has been proven efficacious and safe for pericarditis prevention in more than one clinical trial with a similar effect for primary or secondary prevention. On this basis, the drug should be considered as a first line agent for pericarditis prevention (Journal of Cardiovascular Medicine 2014; in press).