Abstract 13886: Colchicine for Secondary Prevention of Adverse Outcomes From Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Introduction: Recent evidence suggests colchicine may prevent adverse outcomes from cardiovascular disease (CVD). The objective of this study is to perform a meta-analysis of randomized controlled trials (RCTs) testing colchicine’s effect on CVD adverse events and mortality among participants with known CVD. Methods: All RCTs testing colchicine versus control were identified and included in the analysis. The endpoints of interest included CVD adverse events (a composite of acute coronary syndrome, cardiac arrest, acute heart failure and hospitalization, stroke, revascularization, and recurrent myocardial infarction), mortality, and gastrointestinal (GI) adverse events. The primary analysis calculated the summary odds ratio (OR) and 95% confidence intervals (CI) for each endpoint. A secondary analysis tested CVD adverse events for heterogeneity of treatment effect (HTE) using Chi 2 and I 2 tests. Results: 9 RCTs (N = 7,031, mean follow-up 9 months) were identified comparing colchicine to control. Colchicine decreased the risk of CVD adverse events [OR 0.64, 95% CI 0.45-0.91]. Colchicine did not reduce all-cause mortality [OR 0.84, 95% CI 0.61-1.15]. GI adverse events were more likely in the colchicine group [OR 3.03, 95% CI 1.60-5.75, p = 0.0007; I 2 = 83%] but with significant HTE. When performing the test for subgroup differences, there was significant HTE between placebo and open-label trial for CVD events [Chi 2 = 10.55, p = 0.001, I 2 = 90.5%]. After excluding two open-label trials, colchicine reduced the risk of CVD events [OR 0.77, 95% CI 0.63-0.93]. Conclusion: Colchicine was associated with reduced CVD adverse events, but not with reduced mortality, among patients with underlying CVD. Colchicine use was associated with increased GI adverse events. Further studies with longer follow-up times are needed to better understand colchicine’s role in the long-term prevention of CVD adverse events.