The quality of evidence is downgraded by study limitations (lack of blinding).
A Cochrane review [Abstract] 1 included 4 studies with a total of 564 subjects. The effects of colchicine in addition to a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, aspirin or indomethacin was compared to the effects of the NSAID alone. Two studies included patients with recurrent pericarditis and 2 studies patients with acute pericarditis.
In people with recurrent pericarditis colchicine reduced episodes of pericarditis (HR 0.37, 95% CI 0.24 to 0.58; 2 studies, n=204; NNT = 4 at 18 months), and in acute pericarditis colchicine reduced recurrence (HR 0.40, 95% CI 0.27 to 0.61; 2 studies, n=360) over 18 months follow-up. Colchicine led to a greater chance of symptom relief at 72 hours. Recurrences at different time points are shown in table T1.
| Outcome | Relative effect (95% CI) | NSAID | Colchicine+NSAID (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Recurrences in patients with recurrent pericarditis | ||||
| 6 months | RR 0.28 (0.17 to 0.47) | 490 per 1000 | 137 per 1000(83 to 230) | 204 (2 studies) |
| 12 months | RR 0.36 (0.23 to 0.56) | 520 per 1000 | 187 per 1000(120 to 291) | 204 (2 studies) |
| 18 months | RR 0.38 (0.25 to 0.58) | 539 per 1000 | 205 per 1000(135 to 313) | 204 (2 studies) |
| Recurrences in patients with acute pericarditis | ||||
| 6 months | RR 0.36 (0.23 to 0.58) | 306 per 1000 | 110 per 1000(70 to 177) | 360(2 studies) |
| 12 months | RR 0.4 (0.26 to 0.61) | 333 per 1000 | 133 per 1000(87 to 203) | 360(2 studies) |
| 18 months | RR 0.41 (0.28 to 0.61) | 367 per 1000 | 150 per 1000(103 to 224) | 360(2 studies) |
| Symptom relief for (acute or recurrent) pericarditis | ||||
| Symptom relief at 72 hours | RR 1.40 (1.26 to 1.56) | 592 per 1000 | 829 per 1000(746 to 924) | 564 (4 studies) |
Adverse effects were mainly gastrointestinal and included abdominal pain and diarrhoea. There was no statistically significant difference in adverse events between the groups, but treatment with colchicine led to more people stopping treatment due to adverse events (table T2).
| Outcome | Relative effect (95% CI) | NSAID | Colchicine+NSAID (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Total adverse effects | RR 1.26 (0.75 to 2.12) | 82 per 1000 | 103 per 1000(61 to 173) | 564(4 studies) |
| Adverse effects necessitating stop of therapy | RR 1.87 (1.02 to 3.41) | 50 per 1000 | 93 per 1000(51 to 169) | 564(4 studies) |
Another review 2 summarized the data on the efficacy and safety of colchicine in patients with cardiovascular disease. In patients with acute and recurrent pericarditis, colchicine halved the risk of recurrence (RR 0.50, 95% CI 0.42 to 0.60; 9 studies, n=1 745).
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