Efficacy and safety of colchicine for pericarditis prevention : systematic review and meta-analysis

Objectives The purpose of this study was to investigate the efficacy and safety of colchicine for pericarditis prevention. Background Recurrent pericarditis prevention is a major management goal that may reduce morbidity and management costs. Although empiric anti-inflammatory therapy is considered the mainstay of treatment, no specific drug has been proven to be efficacious for prevention but colchicine. 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 primary outcome, adverse events, and drug withdrawal. Results From the initial sample of 127 citations, five controlled clinical trials were finally included (795 patients): three studies were double-blind randomised controlled trials, and two studies were open-label randomised controlled trials. Trials followed patients for a mean of 13 months. Meta-analytic pooling showed that colchicine use was associated with a reduced risk of pericarditis during follow-up (RR-0.40, 95% CI 0.30 to 0.54, p for effect <0.001, p for heterogeneity = 0.95, I-2=0%) either for primary or secondary prevention without a significant higher risk of adverse events compared with placebo (RR-1.22, 95% CI 0.71 to 2.10, p for effect 0.48, p for heterogeneity = 0.44, I-2=0%), but more cases of drug withdrawals (RR=1.85, 95% CI 1.04 to 3.29, p for effect 0.04, p for heterogeneity = 0.42, I-2=0%). Gastrointestinal intolerance is the most frequent side effect (mean incidence 8%), but no severe adverse events were recorded. Conclusions Available evidence suggests that colchicine is safe and efficacious for the primary and secondary prevention of pericarditis.