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Long-term secondary prevention with colchicine in patients with CAD: an updated systematic review and meta-analysis

Patrizia Boracchi1, Giuseppe Marano1, Ester Luconi2

  • 1Medical Statistics Unit, Department of Biomedical and Clinical Sciences, University of Studies of Milan, Milan, Italy.

European Journal of Internal Medicine
|June 7, 2025
PubMed

Insights

Colchicine shows a reduced risk of myocardial infarction (MI) and composite cardiovascular events in coronary artery disease (CAD) patients. While benefits appear attenuated, colchicine remains valuable for reducing MI and major adverse cardiovascular events (MACE).

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Colchicine, an anti-inflammatory agent, has been investigated for its role in cardiovascular disease management.
  • Previous studies suggested potential benefits, but recent trials like CLEAR SYNERGY yielded neutral results for acute myocardial infarction (MI).
  • A comprehensive meta-analysis is needed to re-evaluate colchicine's efficacy and safety in coronary artery disease (CAD).

Purpose of the Study:

  • To conduct a meta-analysis of randomized clinical trials (RCTs) evaluating colchicine's effect on cardiovascular events in patients with CAD.
  • To update estimates of colchicine's benefit on individual endpoints and composite outcomes, including MI, urgent revascularization (UR), stroke, and mortality.
  • To assess the safety profile of colchicine in this patient population.

Main Methods:

  • Searched for the largest RCTs of colchicine in CAD patients.
  • Pooled analysis of individual events (MI, UR, stroke, cardiovascular mortality, total mortality) using hazard ratios (HR) and 95% confidence intervals (CI) via Cox models.
  • Utilized fixed-effects or random-effects models for analysis.
  • Assessed composite endpoints: MACE 1 (MI, UR, cardiovascular mortality) and MACE 2 (stroke, MI, total mortality).
  • Evaluated safety outcomes, including non-cardiovascular mortality and serious adverse events.

Main Results:

  • Five studies with 18,656 patients were included.
  • Colchicine significantly reduced the risk of MI by 21% (HR 0.79, 95% CI: 0.68 - 0.92).
  • Composite endpoints MACE 1 and MACE 2 were reduced (HR 0.81, 95% CI: 0.68 - 0.98 and HR 0.88, 95% CI: 0.79 - 0.98, respectively).
  • No significant effect on total or cardiovascular mortality was observed.
  • Safety assessment showed no differences in non-cardiovascular mortality, cancer, or serious gastrointestinal/infectious events.

Conclusions:

  • Colchicine demonstrates a valuable role in reducing the risk of MI and composite cardiovascular events in CAD patients.
  • Despite an apparent attenuation of benefit compared to earlier analyses, the drug remains significant for preventing MI and MACE.
  • The safety profile appears reassuring, with no increased risk of serious adverse reactions observed in the meta-analysis.

Keywords:
ColchicineCoronary artery diseaseMeta-analysisSecondary prevention

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