Does the addition of colchicine improve outcomes in the treatment of an initial episode of acute pericarditis?
When used in addition to conventional anti-inflammatory therapy, colchicine decreases the rate of incessant or recurrent pericarditis. You would need to treat 4 patients with colchicine to prevent one such episode. (LOE = 1b)
Imazio M, Brucato A, Cemin R, et al, for the ICAP Investigators. A randomized trial of colchicine for acute pericarditis. N Engl J Med 2013;369(16):1522-1528.
Randomized controlled trial (double-blinded)
Inpatient (any location) with outpatient follow-up
Colchicine has been previously shown effective in the prevention of recurrent pericarditis (Daily POEM 12-16-2011). In this study, patients with a first episode of acute pericarditis were randomized to receive either colchicine (0.5 mg - 1 mg daily for 3 months; n = 120) or matching placebo (n = 120). All patients also received conventional treatment for acute pericarditis, either aspirin 800 mg or ibuprofen 600 mg every 8 hours for 7 to 10 days, followed by a taper, or (for those with contraindications to aspirin or ibuprofen) glucorticoid therapy for 2 weeks, followed by a taper. Baseline characteristics in the 2 groups were similar: mean age was 52 years, 60% were male, and the most common cause of pericarditis was idiopathic. The majority of patients received aspirin rather than ibuprofen or glucocorticoids as concomitant therapy. Adherence to the study drug was higher than 95% and did not differ between the 2 groups. Patients were followed up for a mean of 22 months and none were lost to follow-up. Analysis was by intention to treat. The primary outcome of incessant or recurrent pericarditis was decreased in the colchicine group as compared with the placebo group (16.7% vs 37.5%; relative risk = 0.56; 95% CI, 0.30-0.72; P < .001). In addition, the colchicine group had significantly better outcomes with regard to the number of patients with persistent symptoms at 72 hours (19% vs 40%), rate of remission within 1 week (85% vs 58%), time to first recurrence (25 weeks vs 18 weeks), and rate of percarditis-related hospitalizations (5% vs 14%). There was no difference in either overall side effects or gastrointestinal side effects between the 2 groups.
Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.