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A Green Light for Colchicine to Treat Acute Pericarditis

September 2, 2013

A Green Light for Colchicine to Treat Acute Pericarditis

  1. Harlan M. Krumholz, MD, SM

When added to anti-inflammatory agents, the drug significantly improved outcomes after a first attack.

  1. Harlan M. Krumholz, MD, SM

Although some experts have recommended the use of colchicine for acute pericarditis, the recommendation has not been based on strong clinical-trial evidence. To address this gap in knowledge, investigators conducted the randomized, double-blind, ICAP trial at five centers in Italy. They assigned 240 patients with a first episode of acute pericarditis to receive colchicine (0.5 mg twice/day for patients weighing >70 kg and 0.5 daily for those weighing ≤70 kg) or placebo for 3 months. All patients were treated with anti-inflammatory agents, mostly aspirin or ibuprofen.

The primary endpoint, incessant or recurrent pericarditis during 18-month follow-up, occurred significantly less frequently in the colchicine group than in the placebo group (17% vs. 38%; relative risk, 0.56; 95% confidence interval, 0.30–0.72). Also, fewer patients in the colchicine group had persistent symptoms at 72 hours (19% vs. 40%; P=0.001). The remission rate at 1 week was higher in the colchicine group than in the placebo group (85% vs. 58%; P<0.001). Adverse-event rates were similar in the two groups.

Comment

This study strengthens the evidence for the use of colchicine to treat acute pericarditis. Although these results may not surprise many clinicians, having the evidence to support this practice is reassuring.

  • Disclosures for Harlan M. Krumholz, MD, SM at time of publication Consultant / Advisory board United Healthcare Equity ImageCor Speaker's bureau Centrix Grant / research support FDA; NIH-NHLBI; Commonwealth Fund; The Catherine and Patrick Weldon Donaghue Medical Research Foundation; Robert Wood Johnson Foundation; Medtronic Editorial boards BMJ.com/us; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Central European Journal of Medicine; Congestive Heart Failure; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Journal of Cardiovascular Medicine; Circulation: Cardiovascular Quality and Outcomes Leadership positions in professional societies American Board of Internal Medicine (Chair, Assessment 2020 Task Force); American College of Cardiology (CV Research and Scholarly Activity, and Lifelong Learning Oversight Committee); American College of Physicians (CV Research and Scholarly Activity); American Heart Association (CV Research and Scholarly Activity); Centers for Medicare & Medicaid Services (Heart Care Technical Expert Panel); Oklahoma Foundation for Medical Quality (Heart Care Technical Expert Panel); VHA, Inc. (Center of Applied Healthcare Studies External Advisory Board)

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