Clinical Question

Does the addition of colchicine improve outcomes in the treatment of an initial episode of acute pericarditis?

Bottom Line

When used in addition to conventional anti-inflammatory therapy, colchicine decreases the rate of incessant or recurrent pericarditis. You would need to treat four patients with colchicine to prevent one such episode. (Level of Evidence = 1b)

Synopsis

Colchicine has been previously shown to be effective in the prevention of recurrent pericarditis (Daily POEM; December 16, 2011). In this study, patients with a first episode of acute pericarditis were randomized to receive colchicine (0.5 to 1 mg daily for three months; n = 120) or matching placebo (n = 120). All patients also received conventional treatment for acute pericarditis, aspirin (800 mg) or ibuprofen (600 mg) every eight hours for seven to 10 days followed by a taper, or (for those with contraindications to aspirin or ibuprofen) glucocorticoid therapy for two weeks followed by a taper. Baseline characteristics in the two groups were similar: mean age was 52 years, 60% were men, and the most common cause of pericarditis was idiopathic. Most patients received aspirin rather than ibuprofen or glucocorticoids as concomitant therapy. Adherence to the study drug was greater than 95% and did not differ between the two groups. Patients were followed for a mean of 22 months and none were lost to follow-up. Analysis was by intention to treat.

The primary outcome of incessant or recurrent pericarditis was decreased in the colchicine group compared with the placebo group (16.7% vs. 37.5%; relative risk = 0.56; 95% confidence interval, 0.30 to 0.72; P < .001). In addition, the colchicine group had significantly better outcomes with regard to the number of patients with persistent symptoms at 72 hours (19% vs. 40%), rate of remission within one week (85% vs. 58%), time to first recurrence (25 weeks vs. 18 weeks), and rate of pericarditis-related hospitalizations (5% vs. 14%). There was no difference in overall adverse effects or gastrointestinal adverse effects between the two groups.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Inpatient (any location) with outpatient follow-up

Reference: ImazioMBrucatoACeminRet alICAP InvestigatorsA randomized trial of colchicine for acute pericarditis. N Engl J Med.2013; 369( 16): 1522– 1528.