Comparative effectiveness of sodium-glucose cotransporter 2 inhibitors along with colchicine versus colchicine alone among coronary artery disease and type 2 diabetes patients

Abstract

Background: Colchicine, an anti-inflammatory agent, has been demonstrated to reduce adverse cardiovascular events in coronary artery disease (CAD) patients. Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) provide cardiovascular prevention beyond glycemic control including anti-inflammatory effect, and reduced heart failure risk. Given their complementary mechanisms, combining colchicine and SGLT2i may offer synergistic benefits in CAD patients with T2DM, yet the incremental effects of this combination remain underexplored.

Objective: This study aimed to assess the comparative effectiveness of combination therapy of SGLT2i with colchicine vs colchicine alone among patients with CAD and T2DM.

Methods: The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years of age from January 2015 to June 2024. Patients were categorized into two groups: one with a combination therapy of colchicine and SGLT2i and a control group with colchicine alone. Individuals were matched based on CVD risk factors and medications. After propensity score matching, Risk ratios (RR) were used to compare outcomes over follow-up periods of 6 months and 1 year.

Results: After 1:1 propensity score matching, the study cohort comprised 12,235 patients on colchicine and SGLT2i and 12,235 patients in the control group. The study population had a mean age of 71.5 ± 16.7 years. PSM analysis showed that combination therapy of colchicine and SGLT2i in CAD patients was associated with significantly lower risk of major adverse CVD events (MACE) after 6 month (RR, 0.70 (95 %CI 0.61-0.80), p < 0.01), after 1 year (RR, 0.78 (95 %CI 0.70-0.87), p < 0.01), all-cause mortality (ACM) after 6 month (RR, 0.50 (95 %CI 0.43-0.57), P < 0.01), after 1 year (RR, 0.57 (95 %CI 0.51-0.63), p < 0.01), heart failure excacerbation (HFE) after 6 month (RR, 0.80 (95 % CI 0.69-0.93), p < 0.01), after 1 year (RR, 0.81 (95 % CI 0.72-0.92), p < 0.01), and atrial fibrillation (AF) after 6 month (RR, 0.76 (95 %CI 0.63-0.91), p < 0.01) when compared with colchicine alone. However, the risks of ischemic stroke, acute myocardial infarction (AMI) and hemorrhagic stroke were comparable between the colchicine and SGLT2i groups and the colchicine alone group.

Conclusion: This study suggests that SGLT2i use along with colchicine was associated with significantly lower risk of mortality, MACE, and HFE among CAD patients in comparison to colchicine alone.

Keywords: Cardiovascular prevention; Colchicine; Coronary artery disease; SGLT2i.