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Evidence summaries

Colchicine for Pericarditis

Colchicine as adjunctive therapy to NSAIDs appears to be effective in reducing the number of further recurrences in patients with recurrent pericarditis or acute pericarditis. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (lack of blinding).

Summary

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.

Colchicine + NSAID compared with NSAID alone in pericarditis

OutcomeRelative effect (95% CI)NSAIDColchicine+NSAID (95% CI)Participants (studies)
Recurrences in patients with recurrent pericarditis
6 monthsRR 0.28 (0.17 to 0.47)490 per 1000137 per 1000(83 to 230)204 (2 studies)
12 monthsRR 0.36 (0.23 to 0.56)520 per 1000187 per 1000(120 to 291)204 (2 studies)
18 monthsRR 0.38 (0.25 to 0.58)539 per 1000205 per 1000(135 to 313)204 (2 studies)
Recurrences in patients with acute pericarditis
6 monthsRR 0.36 (0.23 to 0.58)306 per 1000110 per 1000(70 to 177)360(2 studies)
12 monthsRR 0.4 (0.26 to 0.61)333 per 1000133 per 1000(87 to 203)360(2 studies)
18 monthsRR 0.41 (0.28 to 0.61)367 per 1000150 per 1000(103 to 224)360(2 studies)
Symptom relief for (acute or recurrent) pericarditis
Symptom relief at 72 hoursRR 1.40 (1.26 to 1.56)592 per 1000829 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).

Adverse effects of colchicine

OutcomeRelative effect (95% CI)NSAIDColchicine+NSAID (95% CI)Participants (studies)
Total adverse effectsRR 1.26 (0.75 to 2.12)82 per 1000103 per 1000(61 to 173)564(4 studies)
Adverse effects necessitating stop of therapyRR 1.87 (1.02 to 3.41)50 per 100093 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).

Clinical comments

Note

Date of latest search:

    References

    • Alabed S, Cabello JB, Irving GJ et al. Colchicine for pericarditis. Cochrane Database Syst Rev 2014;(8):CD010652. [PubMed]
    • Imazio M, Nidorf M. Colchicine and the heart. Eur Heart J 2021;42(28):2745-2760 [PubMed]

Primary/Secondary Keywords