Colchicine for Stroke Prevention: A Systematic Review and Meta-analysis.

There has been recent interest in the role of colchicine in cardiovascular diseases, given the implication of inflammation in the pathogenesis of atherothrombosis. This systematic review assessed the role of colchicine in preventing primary or secondary stroke/transient ischemic attack (TIA) in an adult population.

Four databases were electronically searched: MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), and OpenGrey. Studies were eligible if they reported stroke or TIA incidence as a primary/secondary end point, or as an adverse event. Only case-control studies, cohort studies, and randomized controlled trials (RCTs) were eligible. The primary end point was a pooled estimate using relative risk ratios (RRs) with 95% CIs. Two-sided P values were considered significant if P < 0.05. Statistical heterogeneity was assessed by using the Cochrane Q statistic and the Higgin's I² statistic. An a priori decision was made to conduct a subgroup analysis based on study type.

A total of 5 studies were eligible for inclusion: 4 RCTs and 1 cohort study. There were 77 reported stroke/TIA events of a combined 2170 patients. Pooling all studies, stroke incidence was lower in the colchicine versus non-colchicine users (RR, 0.37; 95% CI, 0.22-0.62; P = 0.0002). There was no statistical heterogeneity (χ² = 2.72; df = 4; P = 0.61; I² = 0%). Pooling 4 RCTs as determined a priori, there was no significant effect of colchicine on stroke incidence (RR, 0.61; 95% CI, 0.17-2.17; P = 0.57). Results of the single cohort study suggested that colchicine reduced stroke incidence (RR, 0.33; 95% CI, 0.19-0.59; P = 0.0002).

Colchicine has a potential protective benefit in both primary and secondary stroke/TIA incidence. Current data are inconclusive, likely due to the small sample sizes of available RCTs. Large-scale pragmatic RCTs are required to provide robust evidence in this domain.