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Colchicine may reduce rate of acute pericarditis
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AMSTERDAM — When added to conventional anti-inflammatory therapy, colchicine reduced the rate of incessant or recurrent pericarditis, according to data from the ICAP study.
The multicenter, randomized, double blind trial was conducted to examine the safety and efficacy of colchicine for the treatment of a first attack of acute pericarditis and the prevention of recurrent pericarditis.
Researchers enrolled 240 adults between August 2005 and December 2010. All were treated at five hospitals in Italy for a first episode of acute pericarditis. The patients received conventional treatment for acute pericarditis, and then were randomly assigned colchicine or placebo. Follow-up lasted at least 18 months.
The data were presented by Massimo Imazio, MD, at ESC Congress 2013 and published simultaneously in The New England Journal of Medicine.
The primary outcome of incessant or recurrent pericarditis occurred in 16.7% of patients assigned colchicine vs. 37.5% assigned placebo (RR reduction in colchicine group=0.56; 95% CI, 0.3-0.72).
Compared with placebo, colchicine was associated with a lower rate of symptom persistence at 72 hours vs. placebo (19% vs. 40%; P=.001), lower rate of recurrence per patient (0.21 vs. 0.52; P=.001) and lower rate of hospitalization related to pericarditis (5% vs. 14.2%; P=.02).
The colchicine group also had a better rate of remission after 1 week (85% vs. 58.3%; P<.001) and a longer time to first recurrence (24.7 vs. 17.7 weeks; P<.001) vs. the placebo group.
Rates of adverse events and drug discontinuation were similar between the two groups. The most common adverse event observed with colchicine was gastrointestinal disturbance, and no serious adverse events occurred. As a result, a loading dose of colchicine, recommended in current guidelines, may not be needed, according to the researchers.
Although the mechanism by which colchicine benefits patients with acute pericarditis is not fully understood, it may be related to its ability to disrupt microtubules and concentrate in leukocytes, the researchers said.
For more information:
Imazio M. Abstract #877. Presented at: the European Society of Cardiology Congress; Aug. 31-Sept. 4, 2013; Amsterdam.
Imazio M. New Engl J Med. 2013;doi:10.1056/NEJMoa1208536.
Disclosure: Acarpia provided the colchicine and placebo. The researchers report no relevant financial disclosures.