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Colchicine effective for secondary prevention of recurrent pericarditis

Clinical Question:
Does colchicine prevent subsequent episodes of pericarditis in patients after a first recurrence?

Bottom Line:
Colchicine is an effective adjunctive treatment for the prevention of more episodes of pericarditis in patients who have already had one recurrence. You would need to treat 3.3 patients with colchicine for 6 months to prevent 1 episode of recurrent pericarditis in the following 18 months. (LOE = 1b)

Reference:
Imazio M, Brucato A, Cemin R, et al, for the CORP (Colchicine for Recurrent Pericarditis) Investigators. Colchicine for recurrent pericarditis. Ann Intern Med 2011;155(7):409-414.  [PMID:21873706]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Government

Allocation:
Concealed

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
Patients who have a recurrent episode of pericarditis are at high risk for subsequent episodes. Using concealed allocation, investigators randomized 120 adults with a first recurrence of pericarditis to receive either colchicine or placebo in addition to conventional anti-inflammatory therapy. Patients with contraindications to colchicine or those with pericarditis due to tuberculous, bacterial, or neoplastic causes were excluded. Conventional anti-inflammatory therapy consisted of scheduled aspirin or ibuprofen for 7 to 10 days with gradual tapering over 3 to 4 weeks. Patients who received aspirin or ibuprofen also were placed on a prophylactic proton pump inhibitor (PPI). For patients with contraindications to aspirin or ibuprofen, prednisone was used at a dose of 0.2 mg to 0.5 mg per kg of body weight daily for 4 weeks with subsequent tapering. It was unclear how many patients required prednisone and whether these patients also received a prophylactic PPI. Colchicine, or placebo, was given as adjunctive therapy at an initial dose of 1 mg to 2 mg on the first day followed by a maintenance dose of 0.5 mg to 1.0 mg daily for 6 months. Patients who weighed less than 70 kg and those who could not tolerate the highest dose received the lower dose but the study did not specify how many patients received the lower dose. Baseline characteristics were similar in the 2 groups; patients had a mean age of 47 years. Analysis was by intention to treat. At 18 months, patients in the colchicine group had a decreased rate of recurrent pericarditis (24% vs 55% in the placebo group; P < .001). Additionally, in the colchicine group, fewer patients had persistent symptoms at 72 hours (23% vs 53%; P = .001) and more patients were in remission at 1 week (82% vs 48%; P < .001). Both groups had similar rates of side effects and drug discontinuation. Of note, the authors described differences in medications that could be used in the colchicine and placebo groups: eg, aspirin or ibuprofen versus prednisone for anti-inflammatory therapy, PPI versus none for gastrointestinal prophylaxis, and low doses versus high doses of colchicine. Such differences have the potential to influence outcomes in this small study.

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