Efficacy and safety of colchicine in patients with coronary artery disease: A systematic review and meta-analysis of randomized controlled trials

Authors:

Ibadete Bytyçi| Gani Bajraktari | Peter E. Penson |Michael Y. Henein | Maciej Banach | the Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group | the International Lipid Expert Panel (ILEP)

First published: 18 August 2021 | https://doi.org/10.1111/bcp.15041

Abstract:

Aims

Inflammation plays a central role in the pathogenesis and clinical manifestations of atherosclerosis. Randomized controlled trials have investigated the potential benefit of colchicine in reducing cardiovascular (CV) events in patients with coronary artery disease (CAD) but produced conflicting results. The aim of this meta-analysis was to evaluate the efficacy and safety of colchicine in patients with CAD.

Methods

We systematically searched selected electronic databases from inception until 10 December 2020. Primary clinical endpoints were: major adverse cardiac events; all-cause mortality; CV mortality; recurrent myocardial infarction; stroke; hospitalization; and adverse medication effects. Secondary endpoints were short-term effect of colchicine on inflammatory markers.

Results

Twelve randomized controlled trials with a total of 13 073 patients with CAD (colchicine n = 6351 and placebo n = 6722) were included in the meta-analysis. At mean follow-up of 22.5 months, the colchicine group had lower risk of major adverse cardiac events (6.20 vs. 8.87%; P < .001), recurrent myocardial infarction (3.41 vs. 4.41%; P = .005), stroke (0.40 vs. 0.90%; P = .002) and hospitalization due to CV events (0.90 vs. 2.87%; P = .02) compared to the control group. The 2 patient groups had similar risk for all-cause mortality (2.08 vs. 1.88%; P = .82) and CV mortality (0.71 vs. 1.01%; P = .38). Colchicine significantly reduced high-sensitivity C-reactive protein (−4.25, P = .001) compared to controls but did not significantly affect interleukin (IL)-β1 and IL-18 levels.

Conclusion

Colchicine reduced CV events and inflammatory markers, high-sensitivity C-reactive protein and IL-6, in patients with coronary disease compared to controls. Its impact on cardiovascular and all-cause mortality requires further investigation.

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ACKNOWLEDGEMENTS

This meta-analysis was prepared independently; no company or institution supported it financially. No professional writer was involved in the preparation of this position paper.

COMPETING INTERESTS

Maciej Banach: speakers bureau: Amgen, Daichii Sankyo, Esperion, Herbapol, KRKA, MSD, Mylan, Novartis, Novo-Nordisk, Sanofi-Aventis, Servier; consultant to Abbott Vascular, Akcea, Amgen, Daichii Sankyo, Esperion, Lilly, MSD, Resverlogix, Sanofi-Aventis; Grants from Amgen, Mylan, Sanofi and Valeant. Gani Bajraktari: speakers bureau: KRKA, Bosnalijek, Novartis, LEK-Sandoz, Boston-Scientific, Trepharm and Alkaloid; consultant to Novartis. Peter E. Penson owns 4 shares in AstraZeneca PLC and has received honoraria and/or travel reimbursement for events sponsored by AKCEA, Amgen, AMRYT, Link Medical, Napp, Sanofi. Michael Y. Henein and Ibadete Bytyçi have no conflict of interest.

CONTRIBUTORS

M.B.: Conceptualization, study design.; I.B.; G.B., M.B.; methodology, data sorting and statistical analysis; I.B., G.B., P.E., M.Y.H., M.B.; drafting the article or revising it critically for important intellectual content. All authors have read and agreed to the published version of the manuscript.

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