Key result
Colchicine plus aspirin significantly reduced recurrent pericarditis compared to aspirin alone after a first episode (11.7% vs 33%; p=0.009) and in recurrent cases (21% vs 45%; p=0.02).
Why the study?
Does colchicine prevent postpericardiotomy syndrome or recurrent pericarditis in patients at risk?
Systematic Review
Does colchicine prevent postpericardiotomy syndrome or recurrent pericarditis in patients at risk?
Absolute Event Rate: 11.7% vs 33%
p-value: p=0.009
Supports colchicine with aspirin for secondary prevention of recurrent pericarditis; leaves primary prevention of postpericardiotomy syndrome indeterminate.
OBJECTIVE: To review the efficacy and safety of colchicine as primary and secondary prophylaxis for pericarditis. DATA SOURCES: We searched MEDLINE, EMBASE, PubMed, BIOSIS Previews, International Pharmaceutical Abstracts, Web of Science, and CENTRAL for controlled studies from database inception date to July 2009. Search terms included colchicine, pericarditis, and postpericardiotomy syndrome (PPS). STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, controlled trials investigating the use of colchicine in preventing pericarditis were included. Data extracted included design, inclusion criteria, demographics, interventions, background therapy, and pericarditis-related clinical outcomes. DATA SYNTHESIS: Data were synthesized qualitatively, given variable study designs. Three trials were identified. A single trial examining primary prevention evaluated the use of colchicine versus placebo for preventing PPS in patients undergoing cardiopulmonary bypass grafting. No significant reduction in PPS was found. Two studies examined secondary prevention of pericarditis, comparing colchicine plus aspirin versus aspirin alone. One study examined using these comparators to treat a first episode of pericarditis. After 3 months, there was a significant reduction in recurrent pericarditis with colchicine plus aspirin (11.7% vs 33%; p = 0.009). Another study examined this same regimen in recurrent pericarditis, finding a significant reduction in recurrence after 6 months (21% vs 45%; p = 0.02). CONCLUSIONS: Despite limitations in study designs, current evidence suggests a role for colchicine in the secondary prophylaxis for recurrent pericarditis. The evidence for use of colchicine as primary prophylaxis in PPS is indeterminate; therefore, colchicine cannot be recommended routinely. While colchicine should be recommended for the prevention of recurrent pericarditis, questions regarding the optimal regimen and long-term safety profile need to be further elucidated.
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Kuo et al. (2009) conducted a systematic review in Pericarditis and postpericardiotomy syndrome. Colchicine vs. Placebo or aspirin alone was evaluated on Recurrent pericarditis after 3 months (following first episode) (p=0.009). Colchicine plus aspirin significantly reduced recurrent pericarditis compared to aspirin alone after a first episode (11.7% vs 33%; p=0.009) and in recurrent cases (21% vs 45%; p=0.02).
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