Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery: A randomized, placebo-controlled trial

Amoli, Ali Izadi; Bozorgi, Ali; Talasaz, Azita Hajhossein; Omran, Abbas Salehi; Mortazavi, Seyedeh Hamideh; Jalali, Arash; Nasirpour, Shaghayegh; Jenab, Yaser

doi:10.1016/j.ahj.2015.09.020

Cited by 20 publications

(37 citation statements)

References 17 publications

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“…The follow-up time was different in each study and reached from one up to 24 months (mean follow-up: 13.6 months). Only five patients were lost to follow-up in one study [18]. No patients lost to follow-up were reported in the remaining studies.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis for the value of colchicine for the therapy of pericarditis and of postpericardiotomy syndrome

Lutschinger

Rigopoulos

Matiakis

et al. 2019

BMC Cardiovasc Disord

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Background Colchicine has been used as anti-inflammatory agent in pericardial effusion (PE). We sought to perform a meta-analysis of randomized trials assessing the efficacy and safety of colchicine in patients with pericarditis or postpericardiotomy syndrome (PPS). Methods In the systematic literature search following the PRISMA statement, 10 prospective randomized controlled studies with 1981 patients with an average follow-up duration of 13.6 months were identified. Results Colchicine reduced the recurrence rate of pericarditis in patients with acute and recurrent pericarditis and reduced the incidence of PPS (RR: 0.57, 95% CI: 0.44–0.74). Additionally, the rate of rehospitalizations as well as the symptom duration after 72 h was significantly decreased in pericarditis (RR 0.33; 95% CI 0.18–0.60; and RR 0.43; 95% CI 0.34–0.54; respectively), but not in PPS. Treatment with colchicine was associated with significantly higher adverse event (AE) rates (RR 1.42; 95% CI 1.05–1.92), with gastrointestinal intolerance being the leading AE. The reported number needed to treat (NNT) for the prevention of recurrent pericarditis ranged between 3 and 5. The reported NNT for PPS prevention was 10, and the number needed to harm (NNH) was 12, respectively. Late colchicine administration > 7 days after heart surgery did not reduce postoperative PE. Conclusions Our meta-analysis confirms that colchicine is efficacious and safe for prevention of recurrent pericarditis and PPS, while it reduces rehospitalizations and symptom duration in pericarditis. The clinical use of colchicine for the setting of PPS and postoperative PE after heart surgery should be investigated in further multicenter RCT.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis for the value of colchicine for the therapy of pericarditis and of postpericardiotomy syndrome

Lutschinger

Rigopoulos

Matiakis

et al. 2019

BMC Cardiovasc Disord

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“…The hypothesis of two separate mechanisms is strengthened by the fact that although colchicine is effective in the prevention of PPS, it does not seem to be effective in the treatment of early postoperative pericardial effusions [202,203]. Figure 4.…”

Section: Future Aspectsmentioning

confidence: 99%

Postpericardiotomy syndrome after cardiac surgery

Lehto

Kiviniemi

2020

Annals of Medicine

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Postpericardiotomy syndrome (PPS) is a well-known complication after cardiac surgery. The syndrome results in prolonged hospital stay, readmissions, and invasive interventions. Previous studies have reported inconsistent results concerning the incidence and risk factors for PPS due to the differences in the applied diagnostic criteria, study designs, patient populations, and procedure types. In recent prospective studies the reported incidences have been between 21 and 29% in adult cardiac surgery patients. However, it has been stated that most of the included diagnoses in the aforementioned studies would be clinically irrelevant. This challenges the specificity and usability of the currently recommended diagnostic criteria for PPS. Moreover, recent evidence suggests that PPS requiring invasive intervention such as the evacuation of pleural and/or pericardial effusion is associated with increased mortality. In the present review, we summarise the existing literature concerning the incidence, clinical features, diagnostic criteria, risk factors, management, and prognosis of PPS. We also propose novel approaches regarding to the definition and diagnosis of PPS. KEY MESSAGES: 1. Current diagnostic criteria of PPS should be reconsidered, and the analyses should be divided into subgroups according to the severity of the syndrome to achieve more clinically applicable and meaningful results in the future studies. 2. In contrast with the previous presumption, severe PPSdefined as PPS requiring invasive interventionswas recently found to be associated with higher all-cause mortality during the first two years after cardiac surgery. The association with an increased mortality supports the use of relatively aggressive prophylactic methods to prevent PPS. 3. The risk factors clearly increasing the occurrence of PPS are younger age, pleural incision, and valve and ascending aortic procedures when compared to CABG.

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“…По данным РКИ [72][73][74][75][76][77][78][79][80] и их метаанализа [81], лечение колхицином пациентов с острым (COPEImazio, ICAPImazio), рецидивирующим перикардитом (COREImazio, CORPUmazio, CORPImazio 2) и ППС (COPPSImazio, COPPSImazio 2) ассоциируется со снижением частоты рецидивов перикардита [отношение шансов (ОШ) 0,57; 95% доверительный интервал (ДИ) 0,44-0,74], частоты повторной госпитализации и длительности симптомов в течение 72 ч (ОШ 0,33; 95% ДИ 0,18-0,60 и ОШ 0,43; 95% ДИ 0,34-0,54 соответственно). Значение NNT (Number Needed to Treat) в отношении предотвращения рецидивов перикардита колеблется от 3 до 5, ППС -10.…”

Section: перикардитunclassified

Prospects for Using Colchicine in Medicine: New Evidence

Alekberova¹,

Насонов

2020

Naučno-praktičeskaâ revmatologiâ

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Иммуновоспалительные заболевания (ИВЗ; immune-mediated inflammatory disease) относятся к числу наиболее тяжелых хронических болезней человека. Ведущими механизмами развития ИВЗ в широком смысле слова являются аутоиммунный и/или аутовоспалительный иммунопатологические процессы, для первого из которых характерно преобладание активации приобретенного, а для второго-врожденного иммунитета. Для лечения ИВЗ применяется широкий спектр противовоспалительных лекарственных препаратов, доминирующим универсальным эффектом которых, независимо от их структуры и «молекулярных» мишеней, является подавление воспаления. Особое место занимает колхицин, представляющий собой алкалоидный экстракт из растения Colchicum autumnale (безвременник осенний), который применяется для лечения воспаления суставов более 2 тыс. лет и обладает уникальными, не до конца расшифрованными механизмами, определяющими его «противовоспалительный» и анальгетический эффект. Благодаря расшифровке «молекулярных» механизмов действия колхицина в отношении подавления аутовоспалительных механизмов иммунопатогенеза ИВЗ интерес к колхицину существенно возрос и способствовал расширению показаний для его применения в медицине. Ключевые слова: колхицин; аутовоспалительные заболевания; подагра; семейная средиземноморская лихорадка; болезнь Бехчета; атеросклероз.

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Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery: A randomized, placebo-controlled trial

Cited by 20 publications

References 17 publications

Meta-analysis for the value of colchicine for the therapy of pericarditis and of postpericardiotomy syndrome

Meta-analysis for the value of colchicine for the therapy of pericarditis and of postpericardiotomy syndrome

Postpericardiotomy syndrome after cardiac surgery

Prospects for Using Colchicine in Medicine: New Evidence

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