1. Colchicine added to standard anti-inflammatory treatment significantly reduced the rate of further recurrences of pericarditis in patients with previous multiple recurrences.
2. Colchicine also reduced the symptom persistence at 72 hours, recurrences per patient, and pericarditis-related hospital admissions. There were no serious adverse effects.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Low-dose colchicine has been shown to be safe and effective for treating acute pericarditis and the first recurrences of pericarditis. Current treatment for multiple recurrences generally consists of immunosuppressive therapies which can be expensive and have potentially more complications and side effects than NSAIDs, corticosteroids, or colchicine. The Colchicine for Recurrent Pericarditis 2 (CORP-2) trial assessed the safety and efficacy of colchicine in treating multiple recurrences of pericarditis in 240 patients aged 18 or older. Participants received either colchicine or placebo daily for 6 months, along with standard anti-inflammatory treatment and a proton-pump inhibitor as gastroduodenal prophylaxis.
Colchicine significantly reduced the rate of further pericarditis recurrences compared to placebo. Additionally, colchicine improved the proportion of patients with remission at 1 week and reduced the symptom persistence at 72 hours, recurrences per patient, and pericarditis-related hospital admissions. GI intolerance was the most common side effect with no serious adverse effects reported. This study was limited in that it excluded children, pregnant/lactating women, and patients with contraindications. Further research is needed to identify the ideal duration of colchicine treatment. Based on the results, the authors suggest that colchicine be considered as a first-line treatment for recurrent pericarditis in addition to acute pericarditis, in the absence of contraindications or specific indications.
Relevant Reading: A Randomized Trial of Colchicine for Acute Pericarditis
In-Depth [randomized controlled trial]: 240 patients with two or more previous recurrences of pericarditis were randomly assigned to receive 0.5mg or 1.0mg of colchicine daily (n=120) or placebo (n=120) for 6 months. Low-dose colchicine (0.5mg) was given if participants weighed ≤70kg or were intolerant of the higher dose. Anti-inflammatory treatment consisted of 800mg aspirin, 600mg ibuprofen, or 50mg indomethacin orally every 8 hours for 7-10 days with tapering over 3-4 weeks. Patients already on corticosteroids or with contraindications to aspirin, ibuprofen, or indomethacin received prednisone (0.2-0.5mg/kg per day for 4 weeks, then tapered). All patients were followed up for at least 18 months, with visits at 1 week; 1, 3, 6, and 12 months; then every 6 months until the end of the study. Testing at each visit included blood chemistry, a complete blood count, an ECG, and an echocardiogram.
Pericarditis reoccurred in 26 patients (21.6%) in the colchicine group vs. 51 patients (42.5%) in the placebo group (relative risk 0.49; 95% confidence interval 0.24–0.65; p=0.0009; number needed to treat = 5). Colchicine reduced symptom persistence at 72 hours (19.2% vs. 44.2%; p=0.0001), recurrences per patient (0.28 vs. 0.63; p=0.0004), and the proportion of pericarditis-related hospital admissions (1.7% vs. 10.0%; p=0.013). Colchicine also improved the proportion of patients who had remission within 1 week (83.3% vs 59.2%; p=0.0001).
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