Efficacy and safety of colchicine in patients with coronary artery disease: A systematic review and meta‐analysis of randomized controlled trials

Abstract

Inflammation plays a central role in the pathogenesis and clinical manifestations of atherosclerosis. Randomized controlled trials have investigated the potential benefit of colchicine in reducing cardiovascular (CV) events in patients with coronary artery disease (CAD) but produced conflicting results. The aim of this meta-analysis was to evaluate the efficacy and safety of colchicine in patients with CAD.Methods: We systematically searched selected electronic databases from inception until 10 December 2020. Primary clinical endpoints were: major adverse cardiac events; all-cause mortality; CV mortality; recurrent myocardial infarction; stroke; hospitalization; and adverse medication effects. Secondary endpoints were shortterm effect of colchicine on inflammatory markers.Results: Twelve randomized controlled trials with a total of 13 073 patients with CAD (colchicine n = 6351 and placebo n = 6722) were included in the meta-analysis.At mean follow-up of 22.5 months, the colchicine group had lower risk of major adverse cardiac events (6.20 vs. 8.87%; P < .001), recurrent myocardial infarction (3.41 vs. 4.41%; P = .005), stroke (0.40 vs. 0.90%; P = .002) and hospitalization due to CV events (0.90 vs. 2.87%; P = .02) compared to the control group. The 2 patient groups had similar risk for all-cause mortality (2.08 vs. 1.88%; P = .82) and CV mortality (0.71 vs. 1.01%; P = .38). Colchicine significantly reduced high-sensitivity C-reactive protein (À4.25, P = .001) compared to controls but did not significantly affect interleukin (IL)-β1 and IL-18 levels. Conclusion:Colchicine reduced CV events and inflammatory markers, highsensitivity C-reactive protein and IL-6, in patients with coronary disease compared to controls. Its impact on cardiovascular and all-cause mortality requires further investigation.

Colchicine — From rheumatology to the new kid on the block: Coronary syndromes and COVID-19

“…Thus, it was found that colchicine significantly reduces the risk of stroke in patients at high cardiovascular risk [34]. In the previously cited meta-analysis by Bytyçi et al [32] it was also shown that the use of colchicine reduced the risk of stroke (Fig. 2).…”

The role of inflammation and the possibilities of inflammation reduction to prevent cardiovascular events

“…A recent systemic review and meta-analysis pooling data from 12 RCTs, similarly shows a lower risk of MACE, recurrent MI, and hospitalization due to CV events, but overall similar all-cause and CV mortality. 101 Based on these results, in the recent ESC Prevention Guidelines (2021), colchicine was indicated as a drug to reduce inflammation and a low dose (0.5 mg once daily) should be considered for the secondary prevention of CV disease, especially in high-risk patients. 102 Figure 1 details the presumed mechanisms by which the aforementioned medications act to reduce systemic inflammation, and local inflammation within atheromatous plaques.…”

The Impact of Mental Stress on Cardiovascular Health—Part II

“…The central role of inflammation in the pathogenesis and clinical manifestation of atherosclerosis has also been confirmed by the reduction in coronary events by colchicine, an anti-inflammatory drug that reduces the inflammatory activity of leukocytes [ 70 , 71 ]. Moreover, in stable patients with previous myocardial infarction and persistent systemic inflammatory response, blocking the interleukin-6 activity directly using the monoclonal antibody canakinumab resulted in significant reduction in high-sensitivity CRP levels and incidence of subsequent CV events, without changes in low-density lipoprotein cholesterol [ 72 ].…”