Meta-analysis of the effect of colchicine on C-reactive protein in patients with acute and chronic coronary syndromes

Abstract

ObjectiveThe anti-inflammatory drug colchicine has recently shown benefits in the prevention of major adverse cardiovascular events (MACE) in patients with the acute coronary syndrome (ACS) and chronic coronary syndromes (CCS). This meta-analysis focuses on understanding Colchicine's effects on the high-sensitivity C-reactive protein (hs-CRP) to provide mechanistic insight to explain its clinical event reduction.Methods A computerized search of MEDLINE was conducted to retrieve journal articles with studies performed on humans from 1 January 2005 to 1 January 2022, using keywords: 'Colchicine AND Coronary', 'Colchicine AND CRP', and 'Colchicine AND Coronary Artery Disease'. Studies were included if they measured hs-CRP changes from baseline, and colchicine or placebo were given to patients with ACS or CCS. ResultsThirteen studies with a biomarker subgroup population of 1636 patients were included in the hs-CRP meta-analysis. Of those 13 studies, 8 studies with a total population of 6016 reported clinical events defined as myocardial infarction (MI), stroke, cardiovascular death, periprocedural MI, repeat angina after PCI and repeat revascularization. Multivariate analysis revealed a weak negative correlation of −0.1056 (P = 0.805) between change in CRP and clinical events. Overall, colchicine treatment resulted in a greater reduction in hs-CRP levels compared with placebo (Mean Difference: -1.59; 95% Confidence Interval, −2.40 to −0.79, P = 0.0001) and clinical events (Odds Ratio: 0.78; 95% Confidence Interval 0.64 to 0.95, P = 0.01) Conclusion Colchicine therapy is associated with a reduction in hs-CRP and clinical events in patients with ACS and CCS. This finding supports colchicine's antiinflammatory efficacy via CRP reduction to explain its clinical benefit.

Weight change and risk of obesity‐related complications: A retrospective population‐based cohort study of a UK primary care database

“…Our results are supported by studies showing that increased weight loss is (mostly) associated with greater improvements in ORCs 25,40–42 . These improvements are believed to be through mechanical effects in, for example, conditions such as osteoarthritis, gastrointestinal reflux disease and obstructive sleep apnoea, 18,40 and through biological effects in different organs on, for example, insulin sensitivity, beta‐cell function, and chronic inflammation 43–45 …”

“…25,[40][41][42] These improvements are believed to be through mechanical effects in, for example, conditions such as osteoarthritis, gastrointestinal reflux disease and obstructive sleep apnoea, 18,40 and through biological effects in different organs on, for example, insulin sensitivity, beta-cell function, and chronic inflammation. [43][44][45] Obesity is associated with a diverse burden of multiple long-term conditions that escalate with increases in BMI, and intervention to reduce excess weight should be a key target to reduce the global burden of multiple long-term conditions, also recognized with, for example, treatment of T2D. 46 The present study adds new knowledge regarding the benefits of weight loss, specifically, that the extent of ORC risk reduction is dependent on the magnitude of weight loss in the context of baseline BMI, and that weight gain is associated with a similar risk increase.…”

C-reactive protein, pharmacological treatments and diet: how to target your inflammatory burden

“…In COLCOT, the placebo-adjusted geometric mean change of measured hsCRP concentrations was −10.1% in the colchicine group [5]. Other smaller scale studies and a recent meta-analysis underscored this effect of colchicine on circulating inflammatory biomarkers [22,27,28 ▪ ]. However, in comparison to the magnitude of CRP reduction after application of interleukin-1β or interleukin-6 inhibitors the efficacy of colchicine is less consistent and of smaller extent [28 ▪ ,29].…”

Anti-inflammatory therapy in atherosclerotic cardiovascular disease: Current reappraisal

“… 30 Colchicine has been seen to reduce hsCRP levels both in CCS and ACS patients as well. 31 In chronic coronary Syndromes it reduces hsCRP levels by 30–40 % and IL-6 levels by 16 %. 32 , 33 Colchicine has been studied in spectrum of coronary artery disease.…”