Key result
Low-dose colchicine cuts MACE ~49% in CAD, but higher doses increase adverse events.
Why the study?
Several meta-analyses have investigated colchicine doses in coronary artery disease, but all dosing regimens had never been compared in a single study.
Do different dosing regimens of colchicine reduce major adverse cardiac events in patients with coronary artery disease?
Meta-Analysis (n=13,539)
Do different dosing regimens of colchicine reduce major adverse cardiac events in patients with coronary artery disease?
Effect estimate: RR 0.51 (95% CI 0.32-0.83)
Low-dose colchicine effectively reduces cardiovascular events in patients with coronary artery disease, while higher doses increase gastrointestinal adverse events without added mortality benefit.
Supports low-dose colchicine in CAD management; confirms dose-specific efficacy while cautioning against higher regimens.
Several meta-analyses have investigated the effects of different doses of colchicine in treating coronary artery disease, but all dosing regimens were never compared in a single study. We aimed to compare the efficacy and safety of 3 dosing regimens of colchicine in patients with coronary artery disease. PubMed, EMBASE, the Cochrane Library, and SCOPUS were searched for randomized controlled trials involving different colchicine doses. Major adverse cardiac events (MACE), all-cause and cardiovascular mortality, recurrent myocardial infarction (MI), stroke, gastrointestinal adverse events (AEs), discontinuation, and hospitalization were evaluated using risk ratio (RR) with 95% confidence interval (CI). A total of 15 randomized controlled trial involving 13,539 patients were included. Pooled results calculated with STATA 14.0 showed that low-dose colchicine significantly reduced MACE (RR, 0.51; 95% CI, 0.32-0.83), recurrent MI (RR, 0.56; 95% CI, 0.35-0.89), stroke (RR, 0.48; 95% CI, 0.23-1.00), and hospitalization (RR, 0.44; 95% CI, 0.22-0.85), whereas high and loading doses significantly increased gastrointestinal AEs (RR, 2.84; 95% CI, 1.26-6.24) and discontinuation (RR, 2.73; 95% CI, 1.07-6.93), respectively. Sensitivity analyses confirmed that 3 dosing regimens did not reduce all-cause and cardiovascular mortality but significantly increased the gastrointestinal AEs, and high dose significantly increased AEs-related discontinuation; loading dose resulted in more discontinuation than low dose. Although differences between 3 dosing regimens of colchicine are not significant, low dose is more effective in reducing MACE, recurrent MI, stroke, and hospitalization than the control, whereas high and loading doses increase gastrointestinal AEs and discontinuation, respectively.
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Wang et al. (2023) conducted a meta-analysis in Coronary artery disease (n=13,539). Colchicine vs. Control was evaluated on Major adverse cardiac events (MACE) (RR 0.51, 95% CI 0.32-0.83). Low-dose colchicine significantly reduced MACE (RR 0.51; 95% CI 0.32-0.83) compared to control in patients with coronary artery disease, whereas high and loading doses increased adverse events.
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