Colchicine in Patients With Acute Coronary Syndrome: Two-Year Follow-Up of the Australian COPS Randomized Clinical Trial

Tong, David; Bloom, Jason; Quinn, Stephen; Nasis, Arthur; Hiew, C.; Roberts‐Thomson, Philip; Adams, Heath; Sriamareswaran, R.; Htun, N.; Wilson, William; Gaal, W. van; Howes, L. G.; Yeap, A.; Yip, Brian; Wu, Sam; Perera, Padeepa; Collins, Nicholas; Yong, A.; Bhindi, Ravinay; Whitbourn, Robert; Lee, A.; Premaratne, Manuja; Asrress, Kaleab; Freeman, Melanie; Amerena, John; Layland, Jamie

doi:10.1161/circulationaha.121.054610

Cited by 73 publications

(139 citation statements)

References 5 publications

(4 reference statements)

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“…These trials demonstrated that colchicine improves disease‐free survival by reducing the risk of myocardial infarction, ischaemic stroke, and ischaemia‐driven revascularisations by 25–30%. Similar benefits out to 2 years were also demonstrated in the COPS (Colchicine in Patients with Acute Coronary Syndrome) trial 12 . These benefits, which are similar to those achieved with statins, were seen in patients with both chronic and recently unstable coronary disease atop of usual therapy.…”

Section: Efficacy Of Colchicine In Coronary Heart Diseasesupporting

confidence: 63%

Emerging evidence for the use of colchicine for secondary prevention of coronary heart disease

Nidorf

Layland

Robinson

et al. 2022

Medical Journal of Australia

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Section: Efficacy Of Colchicine In Coronary Heart Diseasesupporting

confidence: 63%

Emerging evidence for the use of colchicine for secondary prevention of coronary heart disease

Nidorf

Layland

Robinson

et al. 2022

Medical Journal of Australia

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“…The characteristics of the included trials were shown (Table 1 ). Four trials involved colchicine [ 7 – 9 , 20 ]. In addition, four trials compared PLA 2 inhibitors [ 14 – 16 , 21 ], of which three compared varespladib, one compared darapladib.…”

Section: Resultsmentioning

confidence: 99%

“…Firstly, the follow-up duration of all included trials was at least 6 months, the short-term clinical benifts of anti-inflammatory therapy needs further exploration. Secondly, the three small sample size trials had a low incidence of positive events and a wide confidence interval, which reduced the quality of evidence [ 7 , 20 , 21 ]. Thirdly, the lost follow-up rate of three trials was more than 20%, which reduced the reliability of the analysis results [ 16 , 21 , 22 ].…”

Section: Limitationsmentioning

confidence: 99%

Safety and efficacy of anti-inflammatory therapy in patients with coronary artery disease: a systematic review and meta-analysis

Niu

Bai

et al. 2022

BMC Cardiovasc Disord

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Background The inflammation hypothesis of atherosclerosis has been put forward for more than 20 years. Although many animal experiments have suggested that anti-inflammatory therapy can inhibit the atherosclerotic process, the efficacy of anti-inflammatory therapy for patients with coronary artery disease (CAD) is still controversial. Therefore, this study aims to evaluate the safety and efficacy of anti-inflammatory drugs in patients with CAD. Method We conducted this systematic review and meta-analysis of randomized controlled trials by searching PubMed, EMBASE, web of science, and Cochrane Library database. The primary outcome was a composite outcome of cardiovascular death, myocardial infarction (MI), or stroke. The secondary outcomes included individual MI, coronary revascularization, cardiovascular death, all-cause death, and stroke. The relative risk (RR) and 95% confidence intervals (CI) for outcome events were calculated by the fixed effects model, and trial sequential analysis was applied to assess the results. Result A total of ten randomized controlled trials and 60,782 patients with CAD was included. Compared with patients receiving placebo, anti-inflammatory therapy significantly reduced the incidence of the primary outcome in patients with CAD (RR 0.93, 0.89–0.98, P = 0.007). In addition, the anti-inflammatory therapy can also reduce the risk of MI (RR 0.90, 0.84–0.96, P = 0.002) and coronary revascularization (RR 0.74, 0.66–0.84, P < 0.00001) remarkably. However, there was no significant difference in the incidence of cardiovascular death (RR 0.94, 0.86–1.02, P = 0.14), all-cause death (RR 1.00, 0.94–1.07, P = 0.98) and stroke (RR 0.96, 0.85–1.09, P = 0.51) between two groups. Conclusions Anti-inflammatory therapy can reduce the incidence of the primary outcome in patients with CAD, especially the risk of MI and coronary revascularization. However, anti-inflammatory therapy increases the risk of infection. (Registered by PROSPERO, CRD 420212291032).

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“…18 These results support what has previously been reported in Colchicine in Patients with Acute Coronary Syndrome (COPS) trial, which investigated the effect of colchicine (0.5 mg twice daily for the first mo, followed by 0.5 mg daily for 11 mo) in 707 patients with ACS. 34 Colchicine was well-tolerated, but did not impact the outcome events including ACS, revascularization and noncardioembolic ischaemic stroke. Furthermore, it was associated with higher all-cause mortality.…”

Section: Antiinflammatory Thrombosis Outcome Study (Cantos) Trialmentioning

confidence: 96%

“…Furthermore, it was associated with higher all-cause mortality. 34 These somewhat conflicting results suggest that the efficacy of colchicine in CVD might depend upon other clinical aspects of the patient population, dose of colchicine or study design. In this metaanalysis, we have addressed these questions using meta-regression.…”

Section: Antiinflammatory Thrombosis Outcome Study (Cantos) Trialmentioning

confidence: 99%

Efficacy and safety of colchicine in patients with coronary artery disease: A systematic review and meta‐analysis of randomized controlled trials

Bytyçi

Bajraktari

Penson

et al. 2021

Brit J Clinical Pharma

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Inflammation plays a central role in the pathogenesis and clinical manifestations of atherosclerosis. Randomized controlled trials have investigated the potential benefit of colchicine in reducing cardiovascular (CV) events in patients with coronary artery disease (CAD) but produced conflicting results. The aim of this meta-analysis was to evaluate the efficacy and safety of colchicine in patients with CAD.Methods: We systematically searched selected electronic databases from inception until 10 December 2020. Primary clinical endpoints were: major adverse cardiac events; all-cause mortality; CV mortality; recurrent myocardial infarction; stroke; hospitalization; and adverse medication effects. Secondary endpoints were shortterm effect of colchicine on inflammatory markers.Results: Twelve randomized controlled trials with a total of 13 073 patients with CAD (colchicine n = 6351 and placebo n = 6722) were included in the meta-analysis.At mean follow-up of 22.5 months, the colchicine group had lower risk of major adverse cardiac events (6.20 vs. 8.87%; P < .001), recurrent myocardial infarction (3.41 vs. 4.41%; P = .005), stroke (0.40 vs. 0.90%; P = .002) and hospitalization due to CV events (0.90 vs. 2.87%; P = .02) compared to the control group. The 2 patient groups had similar risk for all-cause mortality (2.08 vs. 1.88%; P = .82) and CV mortality (0.71 vs. 1.01%; P = .38). Colchicine significantly reduced high-sensitivity C-reactive protein (À4.25, P = .001) compared to controls but did not significantly affect interleukin (IL)-β1 and IL-18 levels. Conclusion:Colchicine reduced CV events and inflammatory markers, highsensitivity C-reactive protein and IL-6, in patients with coronary disease compared to controls. Its impact on cardiovascular and all-cause mortality requires further investigation.

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Colchicine in Patients With Acute Coronary Syndrome: Two-Year Follow-Up of the Australian COPS Randomized Clinical Trial

Cited by 73 publications

References 5 publications

Emerging evidence for the use of colchicine for secondary prevention of coronary heart disease

Emerging evidence for the use of colchicine for secondary prevention of coronary heart disease

Safety and efficacy of anti-inflammatory therapy in patients with coronary artery disease: a systematic review and meta-analysis

Efficacy and safety of colchicine in patients with coronary artery disease: A systematic review and meta‐analysis of randomized controlled trials

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