Colchicine in Patients With Coronary Artery Disease: A Systematic Review and Meta‐Analysis of Randomized Trials

Kofler, Thomas; Kurmann, Reto; Lehnick, Dirk; Cioffi, Giacomo Maria; Chandran, Sudhakar; Attinger‐Toller, Adrian; Toggweiler, Stefan; Kobza, Richard; Moccetti, Federico; Cuculi, Florim; Jolly, Sanjit S.; Bossard, Matthias

doi:10.1161/jaha.121.021198

Cited by 40 publications

(28 citation statements)

References 44 publications

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“…From a mechanistic standpoint, the anti‐inflammatory effects of colchicine are not only mediated by direct interaction with microtubules and by regulation in cytokine secretion but also due to modifications at the transcriptional level 14 . Thus, longer therapy durations (such as > 28 days) are necessary to establish the full effects of colchicine; thus, we enrolled patients who had tolerated colchicine for > 28 days 15 , 16 . In the DM cohort, the colchicine users had higher frequency of pneumonia than nonusers; therefore, we set the 28-day cutoff point to observe tolerance for colchicine 17 .…”

Section: Methodsmentioning

confidence: 99%

Effects of colchicine use on ischemic and hemorrhagic stroke risk in diabetic patients with and without gout

Yeh

Kuo

Yip

et al. 2022

Sci Rep

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This study aimed to determine the effect of colchicine use on the risk of stroke among patients with diabetes mellitus (DM). We retrospectively enrolled patients with DM between 2000 and 2013 from the Longitudinal Health Insurance Database and divided them into a colchicine cohort (n = 8761) and noncolchicine cohort (n = 8761) by using propensity score matching (PSM). The event of interest was a stroke, including ischemic stroke and hemorrhagic stroke. The incidence of stroke was analyzed using multivariate Cox proportional hazards models between the colchicine cohort and the comparison cohort after adjustment for several confounding factors. The subdistribution hazard model was also performed for examination of the competing risk. The colchicine cohort had a significantly lower incidence of stroke [adjusted hazard ratios (aHR), 95% confidence intervals (95%CI)] (aHR = 0.61, 95%CI = 0.55–0.67), ischemic stroke (aHR = 0.59, 95%CI = 0.53–0.66), and hemorrhagic stroke (aHR = 0.66, 95%CI = 0.53–0.82) compared with the noncolchicine cohort. Drug analysis indicated that patients in the colchicine cohort who received colchicine of cumulative daily defined dose (cDDD) > 14 and duration > 28 days had a lower risk of stroke and ischemic stroke compared with nonusers. The colchicine cohort (cDDD > 150, duration > 360 days) also had a lower risk of stroke, ischemic stroke, and hemorrhagic stroke. The cumulative incidence of stroke, ischemic stroke, and hemorrhagic stroke in the colchicine cohort was significantly lower than that in the noncolchicine cohort (log-rank P < 0.001). However, the subdistribution hazard model reveal the colchicine was not associated with the hemorrhagic stroke in DM patients without gout (aHR = 0.69, 95%CI = 0.47–1.00). Colchicine use with cDDD > 14 and duration > 28 days was associated with lower risk of stroke and ischemic stroke, and colchicine use with cDDD > 150 and duration > 360 days played an auxiliary role in the prevention of stroke, ischemic stroke, and hemorrhagic stroke in patients with DM. The colchicine for the hemorrhagic stroke in DM patients without gout seem to be null effect.

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Section: Methodsmentioning

confidence: 99%

Effects of colchicine use on ischemic and hemorrhagic stroke risk in diabetic patients with and without gout

Yeh

Kuo

Yip

et al. 2022

Sci Rep

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“…Fiolet et al reported the levels of CRP, an inflammatory marker, decreased after 1 month of colchicine treatment, and the MRI findings of myocarditis revealed improvement, thus supporting this finding (39). Similar to meta-analysis of Kofler et al report, the use of colchicine for > 150 days resulted in the lowest risk of HD (40). Thus, colchicine can be used for a long term without drug resistance in HD.…”

Section: Discussionmentioning

confidence: 70%

Colchicine Is a Weapon for Managing the Heart Disease Among Interstitial Lung Disease With Viral Infection: Have We Found the Holy Grail?

Yeh

Hung

Lin

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThis study investigated the effect of colchicine use on the risks of heart disease (HD), pericarditis, endocarditis, myocarditis, cardiomyopathy, cardiac arrhythmia, and cardiac failure in patients having interstitial lung disease (ILD) with virus infection (ILD cohort).MethodsWe retrospectively enrolled ILD cohort between 2000 and 2013 from the Longitudinal Health Insurance Database and divided them into colchicine users (n = 12,253) and colchicine non-users (n = 12,253) through propensity score matching. The event of interest was the diagnosis of HD. The incidence of HD was analyzed using multivariate Cox proportional hazards models between colchicine users and the comparison cohort after adjustment for age, sex, medication, comorbidities, and index date based on the time-dependent analysis.ResultsColchicine users had a significantly lower risk of HD (aHR = 0.87, 95% confidence interval (CI]) = 0.82–0.92) than did the colchicine non-user. For colchicine non-users as the reference, the aHR (95% CI) of the patients who received colchicine of 2–7, 8–30, 31–150, and > 150 days were 0.89 (0.81–0.98), 0.84 (0.76–0.94), 090 (0.80–0.99), and 0.83 (0.74–0.93), respectively; regardless of duration use, the lower risk of HD persisted in colchicine users. The cumulative incidence of HD in colchicine users was significantly lower than that in the colchicine non-users (log-rank p < 0.001).ConclusionThe addition of short-term or long-term colchicine to standard medical therapy may have benefits to prevent the HD among the ILD patients concurrent with a virus infection or comorbidities even in elderly patients.

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“…Initial studies demonstrated that allopurinol, a xanthine oxidase inhibitor, was associated with improved endothelial function in HF patients. 17 Subsequently, the Effects of Xanthine Oxidase Inhibition on Hyperuricemic Heart Failure Patients (EXACT‐HF) study randomized patients (with primarily NYHA Class II and III HFrEF and hyperuricemia) to allopurinol (target dose 600 mg daily) versus placebo for 24 weeks. 18 The primary outcome, a composite clinical end point based on several factors including survival, worsening HF, and patient global assessment, was not significantly different between the allopurinol and placebo groups.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, uric acid lowering therapies have been considered potential medication candidates for improving HF outcomes. Initial studies demonstrated that allopurinol, a xanthine oxidase inhibitor, was associated with improved endothelial function in HF patients 17 . Subsequently, the Effects of Xanthine Oxidase Inhibition on Hyperuricemic Heart Failure Patients (EXACT‐HF) study randomized patients (with primarily NYHA Class II and III HFrEF and hyperuricemia) to allopurinol (target dose 600 mg daily) versus placebo for 24 weeks 18 .…”

Section: Discussionmentioning

confidence: 99%

Association of colchicine use for acute gout with clinical outcomes in acute decompensated heart failure

Roth

Chinn

Dunn

et al. 2022

Clinical Cardiology

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Background Gout is a common comorbidity in heart failure (HF) patients and is frequently associated with acute exacerbations during treatment for decompensated HF. Although colchicine is often used to manage acute gout in HF patients, its impact on clinical outcomes when used during acute decompensated HF is unknown. Methods This was a single center, retrospective study of hospitalized patients treated for an acute HF exacerbation with and without acute gout flare between March 2011 and December 2020. We assessed clinical outcomes in patients treated with colchicine for a gout flare compared to those who did not experience a gout flare or receive colchicine. The primary outcome was in‐hospital all‐cause mortality. Results Among 1047 patient encounters for acute HF during the study period, there were 237 encounters (22.7%) where the patient also received colchicine for acute gout during admission. In‐hospital all‐cause mortality was significantly reduced in the colchicine group compared with the control group (2.1% vs. 6.5%, p = .009). The colchicine group had increased length of stay (9.93 vs. 7.96 days, p < .001) but no significant difference in 30‐day readmissions (21.5% vs. 19.5%, p = .495). In a Cox proportional hazards model adjusted for age, inpatient colchicine use was associated with improved survival to discharge (hazards ratio [HR] 0.163, 95% confidence interval [CI] 0.051−0.525, p = .002) and a reduced rate of in‐hospital CV mortality (HR 0.184, 95% CI 0.044−0.770, p = .021). Conclusion Among patients with a HF exacerbation, treatment with colchicine for a gout flare was associated with significantly lower in‐hospital mortality compared with those not treated for acute gout.

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Colchicine in Patients With Coronary Artery Disease: A Systematic Review and Meta‐Analysis of Randomized Trials

Cited by 40 publications

References 44 publications

Effects of colchicine use on ischemic and hemorrhagic stroke risk in diabetic patients with and without gout

Effects of colchicine use on ischemic and hemorrhagic stroke risk in diabetic patients with and without gout

Colchicine Is a Weapon for Managing the Heart Disease Among Interstitial Lung Disease With Viral Infection: Have We Found the Holy Grail?

Association of colchicine use for acute gout with clinical outcomes in acute decompensated heart failure

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