ESC.13: Colchicine may offer protection against recurrent pericarditis

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Colchicine may not be just for gout anymore. In a study based out of Italy, researchers found that the drug, when used in conjunction with anti-inflammatory medications, reduced the rate of recurrent pericarditis in patients who suffered an initial acute episode. The drug, however, is not approved for this use in North American or Europe. The findings were presented Sept. 1 at the European Society of Cardiology Congress 2013 in Amsterdam and simultaneously published in The New England Journal of Medicine.

The study, called the Investigation on Colchicine for Acute Pericarditis (ICAP), took place at five hospitals in Italy between 2005 and 2010. The trial included 240 patients who experienced a first-time episode of acute pericarditis. The group was split evenly and randomly assigned to receive either colchicine (Colcrys, Takeda) or a placebo for three months in addition to anti-inflammatories, such as ibuprofen, aspirin or prednisone (Deltasone, Pfizer). All participants were followed for at least 18 months.

“Preliminary data from nonrandomized trials have also supported the use of colchicine for the treatment and prevention of acute pericarditis,” wrote the researchers, led by Massimo Imazio, MD, of Maria Vittoria Hospital in Turin, Italy. “However, conclusive data are lacking regarding the use of colchicine during a first attack of acute pericarditis and in the prevention of recurrent symptoms.”

As their primary outcome, the authors determined rates of incessant or recurrent pericarditis. Additional outcomes included symptoms that lasted 72 hours, remission within one week, recurrences, time to first recurrence, pericarditis-related hospitalization, cardiac tamponade and constrictive pericarditis.

There were 20 patients (16.7 percent) in the colchicine group and 45 patients (37.5 percent) in the placebo group who developed incessant or recurrent pericarditis. Colchicine was also effective at lowering the rate of symptom persistence, the number of recurrences and disease-related hospitalizations.

Colchicine was also effective in other secondary outcomes. It lengthened the time to first recurrence and improved remission rates within one week. No patients in the colchicine group developed cardiac tamponade or constrictive pericarditis. In contrast, three patients who received the placebo suffered from cardiac tamponade and one placebo patient developed constrictive pericarditis. There were also no serious adverse events among the experimental group.

While the authors noted that ICAP trial and other studies have suggested colchicine offers protection against pericarditis, precisely how the drug works is still unclear.

They also noted that the small sample size and relatively short length of treatment were among the study’s limitations and encouraged future research.