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Colchicine efficacy and safety for the treatment of cardiovascular diseases

The emerging role of colchicine in the treatment of cardiovascular diseases is a strong demand for a comprehensive understanding of its efficacy and safety. This meta-analysis and systematic review aimed to study the efficacy in the reduction of adverse cardiovascular outcomes (CO), and the risk of...

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Autores principales: Andreis, Alessandro, Imazio, Massimo, Casula, Matteo, Avondo, Stefano, De Ferrari, Gaetano Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947153/
https://www.ncbi.nlm.nih.gov/pubmed/33704674
http://dx.doi.org/10.1007/s11739-021-02654-7
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author Andreis, Alessandro
Imazio, Massimo
Casula, Matteo
Avondo, Stefano
De Ferrari, Gaetano Maria
author_facet Andreis, Alessandro
Imazio, Massimo
Casula, Matteo
Avondo, Stefano
De Ferrari, Gaetano Maria
author_sort Andreis, Alessandro
collection PubMed
description The emerging role of colchicine in the treatment of cardiovascular diseases is a strong demand for a comprehensive understanding of its efficacy and safety. This meta-analysis and systematic review aimed to study the efficacy in the reduction of adverse cardiovascular outcomes (CO), and the risk of colchicine-related adverse events (CRAEs). Fourteen thousand and nine eighty three patients from 22 randomized controlled trials (RCTs) were included, 9 in patients with coronary artery disease—CAD, 9 in patients with pericarditis, 4 in patients with atrial fibrillation—AF or heart failure. Colchicine was efficacious in the reduction of adverse CO across different settings: pericardial diseases (reduced risk of recurrent pericarditis, 17.6% vs. 35%, RR 0.50, 95% CI 0.41–0.61), CAD (reduced risk of cardiac death, myocardial infarction, stroke,coronary revascularization or hospitalization, 6.1% vs. 8.5%, RR 0.73, 95% CI 0.64–0.83), AF (reduced risk of arrhythmia recurrence, 14.2% vs. 22.7%, RR 0.62, 95% CI 0.44–0.88). Colchicine was associated with increased risk of gastrointestinal CRAEs (11.2% vs. 8.8%, RR 1.87, 95% CI 1.41–2.47) and drug discontinuation (5.4% vs. 3.7%, RR 1.58, 95% CI 1.25–1.99). In both cases, the risk was proportional to the daily dose or duration of treatment, possibly due to early drug discontinuation or tolerance. Other CRAEs (muscle-related, liver,hematologic,cutaneous, infections) were not increased by colchicine, as long as all-cause death (2.2% vs. 1.9%, RR 1.11, 95% CI 0.79–1.54) or non-cardiovascular death (1.5% vs. 1%, RR 1.43, 95% CI 0.93–2.19). Colchicine is efficacious and safe for the treatment of cardiovascular diseases. The risk of gastrointestinal CRAEs and drug discontinuation is not significant if colchicine is used at lower doses (0.5 mg daily) or for longer periods of time (> 6 months). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02654-7.
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spelling pubmed-79471532021-03-11 Colchicine efficacy and safety for the treatment of cardiovascular diseases Andreis, Alessandro Imazio, Massimo Casula, Matteo Avondo, Stefano De Ferrari, Gaetano Maria Intern Emerg Med CE-Systematic reviews and meta-analysis The emerging role of colchicine in the treatment of cardiovascular diseases is a strong demand for a comprehensive understanding of its efficacy and safety. This meta-analysis and systematic review aimed to study the efficacy in the reduction of adverse cardiovascular outcomes (CO), and the risk of colchicine-related adverse events (CRAEs). Fourteen thousand and nine eighty three patients from 22 randomized controlled trials (RCTs) were included, 9 in patients with coronary artery disease—CAD, 9 in patients with pericarditis, 4 in patients with atrial fibrillation—AF or heart failure. Colchicine was efficacious in the reduction of adverse CO across different settings: pericardial diseases (reduced risk of recurrent pericarditis, 17.6% vs. 35%, RR 0.50, 95% CI 0.41–0.61), CAD (reduced risk of cardiac death, myocardial infarction, stroke,coronary revascularization or hospitalization, 6.1% vs. 8.5%, RR 0.73, 95% CI 0.64–0.83), AF (reduced risk of arrhythmia recurrence, 14.2% vs. 22.7%, RR 0.62, 95% CI 0.44–0.88). Colchicine was associated with increased risk of gastrointestinal CRAEs (11.2% vs. 8.8%, RR 1.87, 95% CI 1.41–2.47) and drug discontinuation (5.4% vs. 3.7%, RR 1.58, 95% CI 1.25–1.99). In both cases, the risk was proportional to the daily dose or duration of treatment, possibly due to early drug discontinuation or tolerance. Other CRAEs (muscle-related, liver,hematologic,cutaneous, infections) were not increased by colchicine, as long as all-cause death (2.2% vs. 1.9%, RR 1.11, 95% CI 0.79–1.54) or non-cardiovascular death (1.5% vs. 1%, RR 1.43, 95% CI 0.93–2.19). Colchicine is efficacious and safe for the treatment of cardiovascular diseases. The risk of gastrointestinal CRAEs and drug discontinuation is not significant if colchicine is used at lower doses (0.5 mg daily) or for longer periods of time (> 6 months). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02654-7. Springer International Publishing 2021-03-11 2021 /pmc/articles/PMC7947153/ /pubmed/33704674 http://dx.doi.org/10.1007/s11739-021-02654-7 Text en © Società Italiana di Medicina Interna (SIMI) 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle CE-Systematic reviews and meta-analysis
Andreis, Alessandro
Imazio, Massimo
Casula, Matteo
Avondo, Stefano
De Ferrari, Gaetano Maria
Colchicine efficacy and safety for the treatment of cardiovascular diseases
title Colchicine efficacy and safety for the treatment of cardiovascular diseases
title_full Colchicine efficacy and safety for the treatment of cardiovascular diseases
title_fullStr Colchicine efficacy and safety for the treatment of cardiovascular diseases
title_full_unstemmed Colchicine efficacy and safety for the treatment of cardiovascular diseases
title_short Colchicine efficacy and safety for the treatment of cardiovascular diseases
title_sort colchicine efficacy and safety for the treatment of cardiovascular diseases
topic CE-Systematic reviews and meta-analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947153/
https://www.ncbi.nlm.nih.gov/pubmed/33704674
http://dx.doi.org/10.1007/s11739-021-02654-7
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