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Efficacy of colchicine in lower extremity peripheral arterial disease: A meta-analysis
Hritvik Jain1, Nandan Patel2, Maheen Erum3
1Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Insights
Colchicine use in lower-extremity peripheral arterial disease (LEPAD) significantly reduces risks of major adverse limb and cardiovascular events, including amputation and stroke. However, it did not impact all-cause mortality or myocardial infarction rates.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Lower-extremity peripheral arterial disease (LEPAD) poses significant risks for cardiovascular and limb complications due to atherosclerosis-related inflammation.
- Colchicine, known for cardiovascular event prevention, may offer protective benefits in LEPAD management.
Purpose of the Study:
- To evaluate the efficacy of colchicine in reducing adverse outcomes for patients diagnosed with LEPAD.
- To synthesize evidence from existing studies via meta-analysis.
Main Methods:
- A systematic literature search was conducted across major databases up to October 2024.
- Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using a random-effects model.
Main Results:
- Colchicine use in LEPAD patients was associated with significantly lower risks of major adverse limb events (MALE), major adverse cardiovascular events (MACE), ischemic stroke, major amputations, and revascularization.
- No significant reduction was observed for all-cause mortality or myocardial infarction (MI).
Conclusions:
- Colchicine shows potential as an adjunctive therapy for LEPAD, reducing key cardiovascular and limb complications.
- Further large-scale, multicenter randomized controlled trials are necessary to confirm colchicine's effectiveness and safety profile in LEPAD patients.
Background:
Lower-extremity peripheral arterial disease (LEPAD) significantly increases the risk of severe cardiovascular and limb complications, often due to the underlying inflammation from atherosclerosis. Colchicine has gained attention due to its efficacy in the primary and secondary prevention of cardiovascular events and may offer similar protective benefits for LEPAD.
Objectives:
This meta-analysis aimed to evaluate outcomes with colchicine in LEPAD.
Methods:
A systematic literature search was performed on the major bibliographic databases for studies until October 2024. Hazard ratios (HRs) with their corresponding 95% CIs were pooled using the inverse-variance random-effects model.
Results:
Three studies were included with 226,804 patients [113,537: Colchicine and 113,267: Placebo]. The pooled analysis demonstrates colchicine use in patients with LEPAD was associated with a significantly lower risk of major adverse limb events (MALE) [HR: 0.84; 95 % CI: 0.75, 0.94; p = 0.002], major adverse cardiovascular events (MACE) [HR: 0.90; 95 % CI: 0.82, 0.98; p = 0.02], ischemic stroke [HR: 0.97; 95 % CI: 0.94, 0.99; p = 0.02], need for major amputations [HR: 0.81, 95 % CI: 0.75, 0.87; p< 0.00001], and revascularization for lower limb ischemia [HR: 0.81; 95 % CI: 0.72, 0.90; p = 0.0001]. However, no significant reduction was noted for all-cause mortality [HR: 0.87; 95 % CI: 0.74, 1.02; p = 0.09] and myocardial infarction (MI) [HR: 0.98; 95 % CI: 0.95, 1.00; p = .10].
Conclusion:
Colchicine may be a useful adjunctive therapy for reducing the risk of major cardiovascular and limb-related complications in patients with LEPAD, including lower rates of MACE, MALE, stroke, amputation, and limb ischemia. However, it did not significantly reduce all-cause mortality or MI. Notably, the only randomized trial evaluating colchicine's efficacy in LEPAD reported a similar risk of adverse outcomes. Multicenter, adequately powered randomized controlled trials are needed to confirm colchicine's effectiveness in this population.
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