Effect of Treatment with Colchicine after Acute Coronary Syndrome on Major Cardiovascular Events: A Systematic Review and Meta-Analysis of Clinical Trials

Abstract

Aim. Colchicine as an anti-inflammatory drug might be effective in the treatment of atherosclerosis, an inflammatory-based condition. The aim of this systematic review and meta-analysis was to evaluate the impact of colchicine on acute coronary syndrome (ACS). Methods. We searched SCOPUS, PubMed, and Web of Science up to September 27, 2020. All clinical trials which evaluated the effect of colchicine on ACS patients and reported high-sensitivity C-reactive protein (hs-CRP) serum level or gastrointestinal (GI) adverse events with at least 5-day follow-up or death, myocardial infarction (MI), and stroke with at least 30-day follow-up as outcomes were included. Results. Finally, seven publications were analyzed. The results of our study revealed that colchicine has a marginally significant effect on hs-CRP attenuation. Furthermore, colchicine manifested promising results by declining the risk of stroke by 70%. However, MI and primary composite endpoint did not differ between the colchicine and noncolchicine groups. Although colchicine did not significantly increase GI adverse events in the pooled analysis, the dose-dependent effect was detected. Low-dose consumption can avoid GI side effects of colchicine. Conclusion. Colchicine has shown some molecular and clinical promising results in ACS patients. The lack of effect of colchicine on MI and all-cause mortality can be partly attributed to the limitations of previous studies. Since colchicine is an inexpensive and easy-to-access drug that has shown to be safe in low-dose regimens in the clinical setting; it would be worthy that future large-scale well-designed clinical trials address this issue by resolving the limitations of previous investigations.

C-reactive protein deficiency ameliorates experimental abdominal aortic aneurysms

“…Although the detailed mechanism of AAA pathogenesis is still unclear, the involvement of inflammation in the formation and progression of AAAs has become a consensus in this field (38). CRP, as one of the important inflammatory acute phase proteins, is involved in the development of many cardiovascular diseases (39)(40)(41)(42)(43)(44)(45). In this study, we found increased expression of CRP protein in experimental AAAs.…”

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

“…Notably, colchicine has a narrow therapeutic window, and actually, adverse effects related to the administration of colchicine have been extensively evaluated. 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.…”