Colchicine for the prevention of pericarditis: what we know and what we do not know in 2014 – systematic review and meta-analysis

Aims The purpose of this study was to investigate and summarize available evidence on the efficacy and safety of colchicine for pericarditis prevention. Disease recurrence is the major and most common complication of pericarditis and its prevention may reduce morbidity and management costs. Colchicine has been intensively studied in the last decade for pericarditis prevention. Methods Controlled clinical studies were searched in several databases and were included provided they focused on the pharmacologic primary or secondary prevention of pericarditis. We performed a meta-analysis including studies of primary outcome, adverse events and drug withdrawal. Results From the initial sample of 175 citations, seven controlled clinical trials were finally included (1275 patients): five studies were double-blind randomized controlled trials (RCT), and two studies were open-label RCTs. Trials followed patients for a mean of 19 months. Meta-analytic pooling showed that colchicine use was associated with a reduced risk of pericarditis during follow-up [odds ratio (OR) 0.33 (0.25–0.44), P for effect <0.001, P for heterogeneity 0.98, I2 = 0%] either for primary or secondary prevention without a significant higher risk of adverse events [OR 1.28 (0.84–1.93), P for effect = 0.25, P for heterogeneity = 0.72, I2 = 0%], and drug withdrawals compared with placebo [OR 1.54 (0.98–2.41), P for effect = 0.06, P for heterogeneity = 0.54, I2 = 0%]. Gastrointestinal intolerance is the most frequent side-effect (mean incidence 8%), but no severe adverse events were recorded. Conclusion Colchicine is well tolerated and efficacious for the primary and secondary prevention of pericarditis without a significant increase of the risk of side-effects and drug withdrawals.