Association Between Colchicine Treatment and Clinical Outcomes in Patients with Coronary Artery Disease: Systematic Review and Meta-analysis

Abstract

Background: The authors examined the association between colchicine treatment and clinical outcomes in patients with coronary artery disease. Methods: They performed a meta-analysis of randomised controlled trials (RCTs) involving patients with coronary artery disease receiving add-on colchicine to standard treatment compared with standard treatment. They used a mixed-effects Poisson regression model with random intervention effects to estimate the pooled incidence rate ratios (IRR) with 95% CI. Results: Ten RCTs were identified, including 12,819 participants followed up for a median of 6 months. Colchicine was associated with a lower risk of major adverse cardiovascular events (IRR 0.69; 95% CI [0.60–0.79]; number needed to treat for an additional beneficial outcome [NNTB] = 28); MI (IRR 0.77; 95% CI [0.64–0.93]; NNTB = 95) and ischaemic stroke (IRR 0.48; 95% CI [0.30–0.76]; NNTB = 155) and with a higher risk of gastrointestinal adverse events (IRR 1.69; 95% CI [1.12–2.54]; number needed to treat for an additional harmful outcome [NNTH] = 10). Colchicine did not affect all-cause death (IRR 1.09; 95% CI [0.85–1.40]), or cardiovascular death (IRR 0.75; 95% CI [0.51–1.12]), while it was associated with a higher risk of non-cardiovascular death (IRR 1.45; 95% CI [1.04–2.02]; NNTH = 396). Conclusion: The meta-analysis showed that the relative and absolute beneficial treatment effects of colchicine on cardiovascular outcomes outweigh the potential harm for non-cardiovascular mortality. Registration: PROSPERO 2021 CRD42021248874.

Colchicine efficacy comparison at varying time points in the peri-operative period for coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

“…In the peri-procedural period of PCI, our study concluded that the statistics of all-cause mortality events, ISR, and MI were not meaningful, However, they were relevant in reducing the occurrence of post-procedural MACE and preventing in-stent thrombosis, which accords with the conclusions of several recent systematic reviews (33-35). In addition, in a previous meta-analysis of colchicine in CAD, colchicine was useful in avoiding stroke in CAD patients, as demonstrated by a systematic study (36); this study (37) supports the administration of low doses to decrease the occurrence of postoperative adverse events; colchicine decrease the risk of associated cardiovascular events by reducing levels of inflammatory factors, and both studies are consistent with our opinion (38,39); however, this study (40) found colchicine to be effective in preventing recurrent myocardial infarction, which may be related to the fact that t PCI was not used to treat the bulk of the study's experimental group. Nevertheless, none of the previous research assessed the effectiveness of colchicine at various intervals during the PCI perioperative period.…”

Efficacy and safety of different dosing regimens of colchicine in patients with coronary artery disease: a network meta-analysis of 15 randomized controlled trials

“… 62 A previous meta-analysis has also revealed a significant association between the administration of colchicine and AEs and suggested that higher dose was harder to be intolerable. 63 Undoubtedly, the adverse effects caused by higher dose will compromise its therapeutic benefits, therefore leading to the result that higher dose is inferior to lower dose in the therapeutic efficacy. Thus, based on the possible mechanisms of colchicine in exerting anti-inflammation, it is rational to extend the usage of colchicine from secondary prevention to primary prevention for cardiovascular diseases, especially low dose of colchicine 64 ; however, this hypothesis should be evaluated by future studies, such as an ongoing study registered on ClinicalTrials.gov.…”

“… 66 , 67 Nevertheless, such benefits were not attributed to a mortality benefit in this network meta-analysis, which was consistent with the findings of previous meta-analyses. 20 , 63 , 68 It should not be ignored that various disease types were evaluated in eligible studies, therefore inevitably introducing bias to compromise mortality benefit. Moreover, we cannot also eliminate the influence of variations in follow-up durations on mortality.…”

“…To date, many conventional pairwise meta-analyses have systematically evaluated and consistently established the effects and safety of colchicine for the treatment of patients with CAD [19][20][21][22][23][24][25][26]63,68,69 ; however, all these findings from previous meta-analyses did not inform practitioners which dosing regimen may be preferred for these patients. Given this open issue, the current network meta-analysis rationally classified colchicine dose into 3 regimens based on published evidence 26 and first determined the comparative efficacy and safety among 3 dosing regimens.…”

Prognostic Value of Estimated Glucose Disposal Rate in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

“…In addition, aging is exacerbating this trend [ 1 , 2 ]. Therefore, many clinical researchers are committed to exploring residual risk factors in CVD cases, discovering novel targets for intervention and formulating individualized and precise treatment plans [ 3 , 4 , 5 ]. Considered a critical risk factor for CAD, type 2 diabetes mellitus (T2DM) is also rising in terms of prevalence [ 1 , 6 ].…”