Safety and efficacy of colchicine in patients with coronary artery disease: A systematic review and meta-analysis

Background: Given current evidence, the use of colchicine for the prevention of adverse cardiovascular events in patients with coronary artery disease (CAD) remains controversial.

Methods: Multiple databases were queried to identify studies comparing the safety and efficacy of colchicine in patients with acute coronary syndrome (ACS) or stable angina. The relative risk (RR) of major adverse cardiovascular events (MACE) and gastrointestinal (GI) adverse events were calculated using a random-effect model.

Results: Six clinical trials comprising a total of 5820 patients were identified. The pooled RR of MACE (0.64, 95% confidence interval (CI) 0.36-1.14, p = 0.13), ACS (0.62, 95% CI 0.27-1.41, p = 0.25), cardiac arrest (0.74, 95% CI 0.26-2.14, p = 0.58), stent restenosis (0.71, 95% CI 0.41-1.23, p = 0.22) and mortality (0.95, 95% CI 0.63-1.42, p = 0.79) with colchicine was not significantly different from placebo or control groups. The overall RR of revascularization (0.53, 95% CI 0.34-0.83, p = 0.005) and stroke (0.26, 95% CI 0.11-0.62, p = 0.002) was significantly lower while the net RR of GI adverse events was significantly higher (HR 2.66, 95% CI 1.21-5.87, p = 0.02) in the colchicine group. Propensity matched cohort, sensitivity and subgroup analysis based on adjusted MACE and dosages of colchicine all mirrored the overall results.

Conclusion: In patients with CAD presenting with an acute coronary syndrome or stable angina, colchicine might offer no significant reduction in MACE and could potentially be harmful due to a significantly higher risk of GI-related adverse events.

Keywords: Colchicine; Coronary artery disease.