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A meta-analysis evaluating efficacy and safety of colchicine for prevention of major cardiovascular events in patients with coronary artery disease

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Abstract

Background

Inflammatory plays a key role in the development of coronary artery disease (CAD). Colchicine as an anti-inflammatory treatment for CAD has attracted much attention, its efficacy and safety are controversial and deserved further exploration.

Methods and results

To evaluate the efficacy and safety of colchicine for patients with CAD, relevant randomized controlled trials (RCTs) were identified by searching several databases including PubMed, Web of Science, and EMBASE from January 1992 to May 2022. Fourteen eligible trials of colchicine therapy include populations with chronic coronary syndrome (CCS) (N = 2), acute coronary syndrome (ACS) (N = 5), and percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (N = 7), and involve a total of 13,235 patients which include 6654 subjects in colchicine group and 6581 subjects in the respective control arms. The outcome was reported as odds ratio (OR) and 95% confidence interval (CI), as the relative measure of association. Overall, the incidences of major adverse cardiovascular events (MACEs) (OR 0.65; 95% CI 0.54–0.77, p < 0.01), new ACS (OR 0.68; 95% CI 0.57–0.81, p < 0.01), coronary revascularization (OR 0.65; 95% CI 0.53–0.78, p < 0.01), and stroke (OR 0.51; 95% CI 0.32–0.82, p < 0.01), were lower in the colchicine group than in the placebo arm. We did not find a significant reduction in the incidence of atrial fibrillation (OR 0.84; 95% CI 0.68–1.04, p = 0.11), all-cause mortality (OR 1.06; 95% CI 0.83–1.35, p = 0.83), cardiovascular mortality (OR 0.77; 95% CI 0.52–1.15, p = 0.21). However, we found that colchicine did increase non-cardiovascular mortality (OR 1.44; 95% CI 1.04–2.01, p = 0.03). Although the incidence of gastrointestinal events in the colchicine treatment group was higher than that in the placebo arms (OR 2.08; 95% CI 1.39–3.12, p < 0.01), the symptoms disappeared rapidly after drug withdrawal and could be tolerated by most patients. Colchicine did not increase the incidence of infections (OR 1.42; 95% CI 0.82–2.46, p = 0.22), pneumonia (OR 1.55; 95% CI 0.58–4.18, p = 0.39), cancers (OR 0.98; 95% CI 0.79–1.22, p = 0.88), bleeding (OR 1.14; 95% CI 0.41–3.14, p = 0.80).

Conclusions

Colchicine is an effective, relatively safe drug that could be considered for the treatment of CAD. However, we need to pay attention to the increasing occurrence of non-cardiovascular mortality and infection especially pneumonia possibly caused by colchicine.

Graphical abstract

Efficacy and safety of colchicine for patients with CAD. CAD coronary artery disease; RCTs randomized controlled trials; OR odds ratio; MACEs major adverse cardiovascular events; ACS acute coronary syndrome; NNT number needed to treat; NNH number needed to harm

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Data availability

The present study is a meta-analysis of published randomized trials. All data used for analyses are presented in the manuscript.

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Funding

This study was supported by the Liaoning Province Central Guiding Local Science and Technology Foundation (No. 2019JH6/10400005) and the National Natural Science Foundation of China (No. 8217021483).

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Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of China Medical University, Nanjing North Street No. 155, Heping District, Shenyang, 110001, China

    Tao Chen & Bo Yu

  2. Department of Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Guihong Liu

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  1. Tao Chen
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  2. Guihong Liu
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All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.

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Correspondence to Bo Yu.

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Chen, T., Liu, G. & Yu, B. A meta-analysis evaluating efficacy and safety of colchicine for prevention of major cardiovascular events in patients with coronary artery disease. Clin Res Cardiol 112, 1487–1505 (2023). https://doi.org/10.1007/s00392-023-02254-9

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  • DOI: https://doi.org/10.1007/s00392-023-02254-9

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