In meta-analysis, colchicine reduces risk for MACE after PCI
In a meta-analysis of seven trials, colchicine was associated with reduced risk for MACE in patients with CAD who underwent PCI.
As Healio previously reported, colchicine, an anti-inflammatory drug primarily used to treat gout, in the COLCOT trial reduced risk for ischemic CV events in patients with recent MI, and in the LoDoCo2 trial reduced risk for CV events in patients with chronic coronary disease.
Kah Long Aw, MB, BCh, BAO (Hons), junior doctor at Oxford University Hospitals NHS Foundation Trust, and colleagues conducted a systematic review and meta-analysis of seven trials covering 6,660 patients who underwent PCI and were assigned colchicine or to a control group after the procedure. Six studies included patients with ACS within 13.5 days of the procedure, and one included patients with ACS or chronic coronary syndrome. Follow-up ranged from 3 days to 22.6 months.
MACE included in-stent restenosis, repeat vessel revascularization, stroke, stent thrombosis, resuscitated cardiac arrest and all-cause mortality, but did not include MI because the studies did not, according to the researchers.
Compared with controls, the colchicine group had reduced risk for MACE (risk ratio = 0.73; 95% CI, 0.61-0.87; P = .0003) and the studies had minimal heterogeneity (I2 = 6%; P for Cochran Q = .38), Aw and colleagues wrote.
The results were driven by repeat vessel revascularization (risk ratio = 0.47; 95% CI, 0.31-0.72; P = .0004), stent thrombosis (risk ratio = 0.5; 95% CI, 0.25-0.98; P = .05) and stroke (risk ratio = 0.5; 95% CI, 0.31-0.81; P = .005), the researchers wrote, noting there was no difference between the groups in in-stent restenosis or all-cause mortality.
Aw and colleagues found the number needed to treat to prevent one incidence of MACE was 41.
“The beneficial role of colchicine is likely explained by its wide-ranging effects on the inflammatory process,” Aw and colleagues wrote. “Colchicine concentrates in leukocytes and has a primary antimitotic effect against microtubule and spindle formation. It also induces downregulation of various inflammatory pathways further impacting neutrophil activation and recruitment, platelet aggregation and the expression of various cytokines and interleukins.
“For colchicine to encounter clinical practice, further studies are required to fully assess its role in the treatment of ischemic heart disease,” they wrote. “There is promising potential in its use in a PCI setting, but further evaluation particularly in distinguishing between different stents (bare-metal vs. drug-eluting), categorizing patients based on MI type (STEMI vs. non-STEMI), as well as personalizing colchicine use in terms of duration of treatment and dose would be needed.”