Effect of low-dose colchicine in acute and chronic coronary syndromes: A systematic review and meta-analysis.

Abstract

Sparse evidence of the prognostic benefit of the anti-inflammatory drug colchicine in chronic and acute coronary syndromes (CCS/ACS) exists. We performed a systematic search of studies on CCS or ACS comparing colchicine vs. placebo and reporting data on cardiovascular outcomes (primary end points of each study) and/or changes in hs-CRP. Ten studies were selected: three on CCS (LoDoCo, LoDoCo2 and the CCS subgroup of COLCHICINE-PCI; total patient number=6256), three on ACS (COLCOT, COPS, ACS subgroup of COLCHICINE-PCI; n=5,654) and five (n=532) on hs-CRP changes from 1week to 12months, in CCS and/or ACS. In patients with CCS, colchicine reduced by 49% risk of a composite end point (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32 to 0.81, P=.005). The favourable effect of colchicine on the risk of cardiovascular events did not change when excluding COLCHICINE-PCI from analysis (HR 0.51, 95% CI 0.25 to 1.03, P=.061). In patients with ACS, the use of colchicine tended to decrease the occurrence of the combined end point compared with placebo (HR=0.77, 95% CI 0.56 to 1.05, P=.100), and colchicine became significantly protective when removing COLCHICINE-PCI from analysis (HR=0.72, 95% CI 0.56 to 0.92, P=.009). Furthermore, colchicine tended to reduce the hs-CRP increase (standardized mean difference=-0.31, 95% CI -0.72 to 0.1, P=.133) compared with placebo. Colchicine therapy near halves the risk of cardiovascular events in CCS compared with placebo and is associated with a nonsignificant 23% risk reduction in ACS, together with a trend towards a greater reduction of hs-CRP.