Effectiveness of colchicine for the prevention of recurrent pericarditis and post-pericardiotomy syndrome: an updated meta-analysis of randomized clinical data

Abstract

The aim of this study is to assess the safety and efficacy of colchicine in prevention of recurrence, symptom reduction, and complications in patients with pericarditis. Pericarditis is an important cause of chest pain leading to frequent emergency room visits and reduced quality of life. Pericarditis has traditionally been treated symptomatically with anti-inflammatory drugs, but growing evidence suggests the use of colchicine for both first episode and recurrent pericarditis in the prevention of recurrences and reducing symptoms. PubMed, EMBASE, and the Cochrane Central register of controlled trials (CENTRAL) databases were searched and the studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. All randomized clinical trials with head-to-head comparison between colchicine and standard of care were included. A total of five studies were included in the primary analysis of pericarditis and three in the analysis for prevention of post-pericardiotomy syndrome (PPS). Colchicine reduced the incidence rate of recurrent pericarditis in patients with both the first episode and recurrent pericarditis, compared with placebo [16.7 vs. 36.8%; risk ratio (RR) 0.46; 95% confidence interval (CI) 0.36-0.58; P < 0.00001; I(2) = 0%], with a significant increase in adverse effects (12.5 vs. 8.5%, RR 1.45; 95% CI 1.09-1.95; P = 0.01; I(2) = 0%) and drug withdrawal rate (10.8 vs. 8.5%; RR 1.44; 95% CI 1.01-2.05; P = 0.04; I(2) = 14%). In addition, colchicine decreased symptom duration in patients with recurrent pericarditis (63.1 vs. 78.6%; RR 0.58; 95% CI 0.39-0.87; P = 0.02; I(2) = 65%), but had no significant effect on symptom duration in patients with an initial episode of pericarditis (RR 0.91; 95% CI 0.65-1.28; P = 0.57; I(2) = 0%). Colchicine was superior to placebo in the prevention of PPS at 1 year (13.2 vs. 25.8%, RR 0.56, 95% CI 0.42-0.76; P < 0.01). In this quantitative analysis of randomized clinical data, colchicine demonstrated superior clinical efficacy compared with standard therapy for the prevention of recurrent pericarditis and PPS at the cost of a small increase in the incidence rate of side effects.

Keywords: Colchicine; Pericarditis; Post-pericardiotomy syndrome.