Systematic Review/Meta-analysisColchicine for Secondary Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Section snippets
Data sources
Medline (PUBMED), EMBASE, and Cochrane central were searched to identify RCTs comparing colchicine with placebo or no colchicine for secondary prevention of CVD (inception to September 1, 2020). To maximized sensitivity, citation chasing was performed in Google Scholar, Scopus, and Web of Science. Secondary prevention was defined as prevention of events in patients with clinically manifest or established CAD. Query terms included colchicine, coronary artery disease, acute coronary syndrome,
Literature search results and risk of bias
The search strategy identified 79 studies. After the first- and second-level screening processes, 4 RCTs were retained in the current meta-analysis. The characteristics of included RCTs are listed in Table 1. The LoDoCo and LoDoCo2 trials assessed the efficacy of colchicine in patients with stable CAD (defined as clinically stable for ≥6 months).11,12 In comparison, COLCOT was conducted in patients who had recent MIs (≤ 30 days), and the COPS trial enrolled patients with ACS.10,13
The pooled
Discussion
In this contemporary meta-analysis of RCTs comparing colchicine to placebo (or no colchicine) for secondary prevention of CVD, we found that (1) treatment with colchicine was associated with a 32% reduction in the incidence of major CV events; (2) significantly fewer MIs, ischemic strokes, and urgent coronary revascularizations were the primary drivers for the overall decrease in CV events; (3) the protective treatment effect of colchicine was relatively consistent among most subgroups studied;
Conclusions
In patients with CAD, the addition of low-dose colchicine to standard medical therapy consistently and significantly reduces the incidence of major CV events compared with standard medical therapy alone. With the exception of CV mortality, significant reductions were observed for components of the primary outcome including MIs, ischemic strokes, and urgent coronary revascularizations.
Funding Sources
COLCOT was supported by the Government of Québec, the Canadian Institutes of Health Research, and philanthropic funds, with the funds administered by the Montréal Heart Institute. Dr Samuel is supported by a postdoctoral fellowship training award from Fonds de recherche du Québec-Santé (FRQS).
Disclosures
Dr Tardif has received grant support from Amarin, Esperion, Ionis Pharmaceuticals, and RegenXBio; grant support and honoraria from AstraZeneca, Pfizer, Sanofi, and Servier; grant support and honoraria from—and minor equity interest in—DalCor Pharmaceuticals. He holds a pending patent (US20170233812A1) on genetic markers for predicting responsiveness to therapy with a high-density lipoprotein (HDL)-raising or HDL mimicking agent and pending patents (62/935,751 and 62/935,865) on methods for
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