Colchicine – new horizons for an ancient drug. Review based on the highest hierarchy of evidence

Schattner, Ami

doi:10.1016/j.ejim.2021.10.002

Cited by 14 publications

(6 citation statements)

References 71 publications

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“…A recent review of all randomized controlled trials, systematic reviews and meta-analyses of colchicine over the last two decades concluded that in the low doses used in most trials, colchicine was generally safe and well-tolerated. Gastrointestinal side effects were a notable exception, especially diarrhea in approximately 10% of colchicine users, but this was often mild, transient, and likely to resolve with dose reduction or drug discontinuation [26].…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of colchicine in prevention of atrial fibrillation following cardiothoracic surgery or cardiac intervention

Zhao

Chen

Mao

et al. 2022

J Cardiothorac Surg

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Background Postoperative atrial fibrillation (POAF) is the most common complication after cardiothoracic surgery or cardiac intervention. Colchicine is an anti-inflammatory agent that was associated with improved cardiovascular outcomes. However, its effect on POAF prevention was inconsistent across studies. Therefore, the aim of this meta-analysis was to evaluate the efficacy of colchicine in prevention of POAF. Methods We searched PubMed, Embase, ClinicalTrials.gov, Cochrane Library database and Google Scholar for randomized controlled trials (RCTs), using terms "atrial fibrillation” and “colchicine". The primary end point was the occurrence of clinically diagnosed atrial fibrillation. The relative risk (RR) and 95% confidence interval (CI) were evaluated. Estimates were pooled using DerSimonian-Laird random-effects model. We also performed subgroup analyses based on the duration and dose of colchicine treatment. Results A total of 9 RCTs were included in this meta-analysis, enrolling a total of 2031 patients. Colchicine significantly reduces the incidence of POAF (RR 0.62; 95% CI, 0.52–0.74, P < 0.001, I2 = 0%). Subgroup analyses indicated that the protective effect of colchicine on POAF was slightly stronger in the long-duration group (RR 0.60; 95% CI, 0.48–0.75, P < 0.001, I2 = 0%) than in the short-duration group (RR 0.65; 95% CI, 0.49–0.86, P < 0.001, I2 = 0%). Conclusion Colchicine is effective in preventing the occurrence of POAF. The efficacy of colchicine can be slightly increased over treatment duration, with no obvious adverse reactions.

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Section: Resultsmentioning

confidence: 99%

A meta-analysis of colchicine in prevention of atrial fibrillation following cardiothoracic surgery or cardiac intervention

Zhao

Chen

Mao

et al. 2022

J Cardiothorac Surg

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“…The use of colchicine for the prophylaxis of fever episodes of PFAPA is mostly based on the experience of patients with FMF (9). In addition to FMF, colchicine has been suggested for treating a varying spectrum of inflammatory disorders, including idiopathic recurrent pericarditis, coronary artery disease, recurrent aphthous stomatitis and Behcet's disease (19,20). The anti-inflammatory and anti-fibrotic effects of colchicine were mainly due to the blockage of assembly and polymerization of microtubules.…”

Section: Discussionmentioning

confidence: 99%

Periyodik Ateş Aftöz Stomatit Farenjit Servikal Adenit Sendromlu Çocuklarda Kolşisin Yanıtının Belirleyicileri

KISAOĞLU,

BABA,

KALYONCU

2023

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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Colchicine prophylaxis is one of the treatment options in management of patients with periodic fever aphthous stomatitis pharyngitis and cervical adenitis (PFAPA) syndrome, but variability exists in response to the treatment. Here we aimed to investigate the efficacy of colchicine prophylaxis and factors associated with a favorable response. Patients diagnosed with PFAPA in whom colchicine was employed before 5 years old age were included. Response to the prophylaxis was assessed by the change of fever intervals and an increase of fever interval >50% after treatment was accepted as favorable response. Complete response was defined as a fever free interval of > 3 months in patients displayed favorable response. Among 41 patients, a favorable response, was observed in 20 (48.8%) patients, and among favorable responders, 8 (19.5%) patients displayed complete response. Of the remaining patients without a favorable response, 9 (22%) demonstrated no response to colchicine prophylaxis. Despite colchicine response was not associated with clinical and laboratory features including MEFV mutations and previous corticosteroid usage, shorter fever intervals were found to be significantly increased the odds of a favorable response to colchicine, which might aid in therapeutic decisions in management of patients with PFAPA.

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“… 19 , 20 Colchicine is an alkaloid with potent anti-inflammatory properties and has been shown to be of substantial clinical value in multiple cardiovascular conditions including recurrent pericarditis, myocardial infarction, stroke, arrhythmias, and heart failure. 25–27 It exerts its anti-inflammatory role by inhibiting microtubule depolymerization, which at the same time negatively affects the phosphorylation of calcium channels, further decreasing the possibility of calcium overload-induced tachyarrhythmias. 28 , 29 Polymerization of microtubules is known to be related to myocardial ion handling and arrhythmogenesis; therefore, there is a possibility that the anti-mitotic action of colchicine also plays a role in its protective effect on POAF.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of colchicine for the prevention of post-operative atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

et al. 2023

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Background and Aims Colchicine is an anti-inflammatory drug that may prevent postoperative atrial fibrillation (POAF). The effect of this drug has been inconsistently shown in previous clinical trials. We aimed to compare the efficacy and safety of colchicine versus placebo to prevent POAF in patients undergoing cardiac surgery. Methods A systematic search of EMBASE, MEDLINE, SCOPUS, ClinicalTrials.gov, and the Cochrane Library for randomized controlled trials (RCTs) was conducted from inception till April 2023. The primary outcome was the incidence of POAF after any cardiac surgery. The secondary outcome was the rate of drug discontinuation due to adverse events and adverse gastrointestinal events. Risk ratios (RR) were reported using the Mantel Haenszel method. Results A total of 8 RCTs comprising 1,885 patients were included. There was a statistically significant lower risk of developing POAF with colchicine vs. placebo (RR: 0.70; 95% CI: 0.59-0.82; p<0.01, I2=0%), and this effect persisted across different subgroups. There was a significantly higher risk of adverse gastrointestinal events (RR: 2.20; 95% CI: 1.38-3.51; p<0.01, I2=55%) with no difference in the risk of drug discontinuation in patients receiving colchicine vs. placebo (RR: 1.33; 95% CI: 0.93-1.89; p=0.11, I2=0%). Conclusion This meta-analysis of 8 RCTs shows that colchicine is effective at preventing POAF, with a significantly higher risk of adverse gastrointestinal events but no difference in the rate of drug discontinuation. Future studies are required to define the optimal duration and dose of colchicine for the prevention of POAF.

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Colchicine – new horizons for an ancient drug. Review based on the highest hierarchy of evidence

Cited by 14 publications

References 71 publications

A meta-analysis of colchicine in prevention of atrial fibrillation following cardiothoracic surgery or cardiac intervention

A meta-analysis of colchicine in prevention of atrial fibrillation following cardiothoracic surgery or cardiac intervention

Periyodik Ateş Aftöz Stomatit Farenjit Servikal Adenit Sendromlu Çocuklarda Kolşisin Yanıtının Belirleyicileri

Safety and efficacy of colchicine for the prevention of post-operative atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

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