Key result
Colchicine significantly reduced the overall risk of pericarditis recurrence and postpericardiotomy syndrome compared to placebo (RR 0.57).
Why the study?
Colchicine has been used as an anti-inflammatory agent in pericardial effusion, but randomized trials required meta-analytic evaluation for its efficacy and safety in pericarditis or postpericardiotomy syndrome.
Does colchicine reduce the recurrence rate of pericarditis and incidence of postpericardiotomy syndrome in patients with pericarditis or PPS?
Meta-Analysis (n=1,981)
Does colchicine reduce the recurrence rate of pericarditis and incidence of postpericardiotomy syndrome in patients with pericarditis or PPS?
Relative Risk: 0.57 (95% CI 0.44–0.74)
Colchicine is effective for preventing recurrent pericarditis and postpericardiotomy syndrome, reducing rehospitalizations and symptom duration, despite an increased risk of gastrointestinal adverse events.
Supports colchicine for pericarditis/PPS prevention; reinforces consensus from 10 pooled RCTs.
BACKGROUND: Colchicine has been used as anti-inflammatory agent in pericardial effusion (PE). We sought to perform a meta-analysis of randomized trials assessing the efficacy and safety of colchicine in patients with pericarditis or postpericardiotomy syndrome (PPS). METHODS: In the systematic literature search following the PRISMA statement, 10 prospective randomized controlled studies with 1981 patients with an average follow-up duration of 13.6 months were identified. RESULTS: Colchicine reduced the recurrence rate of pericarditis in patients with acute and recurrent pericarditis and reduced the incidence of PPS (RR: 0.57, 95% CI: 0.44-0.74). Additionally, the rate of rehospitalizations as well as the symptom duration after 72 h was significantly decreased in pericarditis (RR 0.33; 95% CI 0.18-0.60; and RR 0.43; 95% CI 0.34-0.54; respectively), but not in PPS. Treatment with colchicine was associated with significantly higher adverse event (AE) rates (RR 1.42; 95% CI 1.05-1.92), with gastrointestinal intolerance being the leading AE. The reported number needed to treat (NNT) for the prevention of recurrent pericarditis ranged between 3 and 5. The reported NNT for PPS prevention was 10, and the number needed to harm (NNH) was 12, respectively. Late colchicine administration > 7 days after heart surgery did not reduce postoperative PE. CONCLUSIONS: Our meta-analysis confirms that colchicine is efficacious and safe for prevention of recurrent pericarditis and PPS, while it reduces rehospitalizations and symptom duration in pericarditis. The clinical use of colchicine for the setting of PPS and postoperative PE after heart surgery should be investigated in further multicenter RCT.
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Lutschinger et al. (2019) conducted a meta-analysis in Pericarditis and postpericardiotomy syndrome (PPS) (n=1,981). Colchicine vs. Placebo was evaluated on Recurrence rate of pericarditis and incidence of PPS (RR 0.57, 95% CI 0.44-0.74). Colchicine significantly reduced the overall risk of pericarditis recurrence and postpericardiotomy syndrome compared to placebo (RR 0.57).
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