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Colchicine in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Trials
Thomas Kofler1, Reto Kurmann1, Dirk Lehnick2
1Cardiology Division Heart Center Luzerner Kantonsspital Lucerne Switzerland.
Insights
Colchicine, an anti-inflammatory drug, effectively reduces myocardial infarction and stroke risk in coronary artery disease (CAD) patients. However, it increases gastrointestinal side effects without impacting overall mortality.
Area of Science:
- Cardiology
- Pharmacology
- Inflammation Research
Background:
- Inflammation is a key factor in coronary artery disease (CAD).
- Colchicine, an anti-inflammatory agent, is being investigated for its potential benefits in CAD patients.
- Existing data on colchicine's safety and mortality impact in CAD is inconclusive.
Purpose of the Study:
- To systematically review and meta-analyze randomized trials evaluating colchicine's efficacy and safety in acute and chronic CAD.
- To assess colchicine's impact on ischemic events, mortality, and adverse effects in CAD patients.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) sourced from MEDLINE, EMBASE, Cochrane CENTRAL, and conference abstracts (1975-2020).
- Included 13 RCTs with 13,125 patients comparing colchicine to placebo or standard therapy.
- Employed random-effects models for data synthesis and trial sequential analyses to assess evidence reliability.
Main Results:
- Colchicine significantly reduced the risk of myocardial infarction (MI) (OR 0.64) and stroke/transient ischemic attack (TIA) (OR 0.50) compared to placebo.
- No significant influence of colchicine on all-cause mortality (OR 0.96) or cardiovascular mortality (OR 0.82) was observed.
- Colchicine use was associated with an increased risk of gastrointestinal side effects (P<0.001).
- Trial sequential analyses confirmed sufficient evidence only for MI risk reduction.
Conclusions:
- Colchicine demonstrates efficacy in reducing myocardial infarction and stroke risk for patients with coronary artery disease.
- The benefits of colchicine in CAD are accompanied by an increased incidence of gastrointestinal adverse events.
- Colchicine does not appear to influence all-cause mortality in patients with CAD.
Abstract:
Background Inflammation plays a pivotal role in coronary artery disease (CAD). The anti-inflammatory drug colchicine seems to reduce ischemic events in patients with CAD. So far there is equipoise about its safety and impact on mortality. Methods and Results To evaluate the utility of colchicine in patients with acute and chronic CAD, we performed a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane CENTRAL and conference abstracts were searched from January 1975 to October 2020. Randomized trials assessing colchicine compared with placebo/standard therapy in patients with CAD were included. Data were combined using random-effects models. The reliability of the available data was tested using trial sequential analyses . Of 3108 citations, 13 randomized trials (n=13 125) were included. Colchicine versus placebo/standard therapy in patients with CAD reduced risk of myocardial infarction (odds ratio [OR] 0.64; 95% CI, 0.46-0.90; P=0.01; I2 41%) and stroke/transient ischemic attack (OR 0.50; 95% CI, 0.31-0.81; P=0.005; I2 0%). But treatment with colchicine compared with placebo/standard therapy had no influence on all-cause and cardiovascular mortality (OR 0.96; 95% CI, 0.65-1.41; P=0.83; I2 24%; and OR 0.82; 95% CI, 0.55-1.22; P=0.45; I2 0%, respectively). Colchicine increased the risk for gastrointestinal side effects (P<0.001). According to trial sequential analyses, there is only sufficient evidence for a myocardial infarction risk reduction with colchicine. Conclusions Among patients with CAD, colchicine reduces the risk of myocardial infarction and stroke, but has a higher rate of gastrointestinal upset with no influence on all-cause mortality.
