Colchicine as an Adjuvant Therapy for Coronary Artery Disease: A Systematic Review
Background:Inflammation plays a significant role in atherosclerosis at all phases. Colchicine is a pleiotropic anti-inflammatory agent that may be beneficial in various stages of coronary artery disease (CAD).
Methods:We searched for literatures in PubMed, Cochrane Library, ScienceDirect, and Proquest regarding the use of colchicine on top of current optimal medical therapy for CAD.
Results: Twelve studies were identified: three studies in stable CAD patients and the remaining nine assessed in acute coronary syndrome (ACS) and post-ACS patients. The majority of studies used a colchicine dose of 0.5 mg/day. Adjuvant colchicine of 0.5 mg daily reduced the risk of developing ACS, cardiac arrest, or ischemic stroke in stable CAD: HR (hazard risk) 0.33 (95% CI 0.18-0.59), p<0.001. Patients admitted with ACS who received a 2 mg loading dose of colchicine pre-percutaneous coronary intervention (PCI) showed smaller infarct size than control: 18.3 (IQR 7.6-29.9) ml/1.73 m2vs 23.2 (18.5-33.4) ml/1.73 m2(p=0.019).In post-ACS patients, adjuvant colchicine of 0.5 mg daily significantly reduced the rate of ischemic cardiovascular events: HR 0.77 (95% CI 0.61-0.96), p=0.02.
Conclusion: Stable CAD patients benefit from 0.5 mg daily dose of adjuvant colchicine to reduce the incidence of future cardiovascular events. For patients presenting with ACS, a loading dose of 2 mg of colchicine pre-PCI followed by a week of 0.5 mg colchicine twice daily on top of optimal medical care can reduce infarct size. This should be followed by consumption of 0.5 mg daily dose of adjuvant colchicine post-ACS for at least 20 months to prevent future reinfarctions.
2. Kajikawa M, Higashi Y, Tomiyama H, Maruhashi T, Kurisu S, Kihara Y, et al. Effect of short-term colchicine treatment on endothelial function in patients with coronary artery disease. International Journal of Cardiology. 2019;281:35-9.
3. Martínez GJ, Robertson S, Barraclough J, Xia Q, Mallat Z, Bursill C, et al. Colchicine Acutely Suppresses Local Cardiac Production of Inflammatory Cytokines in Patients With an Acute Coronary Syndrome. J Am Heart Assoc. 2015;4(8):e002128-e.
4. Robertson S, Martínez Gonzalo J, Payet Cloe A, Barraclough Jennifer Y, Celermajer David S, Bursill C, et al. Colchicine therapy in acute coronary syndrome patients acts on caspase-1 to suppress NLRP3 inflammasome monocyte activation. Clinical Science. 2016;130(14):1237-46.
5. Tardif J-C, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. New England Journal of Medicine. 2019;381(26):2497-505.
6. Vaidya K, Arnott C, Martínez GJ, Ng B, McCormack S, Sullivan DR, et al. Colchicine Therapy and Plaque Stabilization in Patients With Acute Coronary Syndrome. A CT Coronary Angiography Study. 2018;11(2 Part 2):305-16.
7. Hennessy T, Soh L, Bowman M, Kurup R, Schultz C, Patel S, et al. The Low Dose Colchicine after Myocardial Infarction (LoDoCo-MI) study: A pilot randomized placebo controlled trial of colchicine following acute myocardial infarction. American Heart Journal. 2019;215:62-9.
8. Vaidya K, Martínez G, Patel S. The Role of Colchicine in Acute Coronary Syndromes. Clinical Therapeutics. 2019;41(1):11-20.
9. Newby LK. Inflammation as a Treatment Target after Acute Myocardial Infarction. New England Journal of Medicine. 2019;381(26):2562-3.
10. Nidorf M, Thompson PL. Effect of Colchicine (0.5 mg Twice Daily) on High-Sensitivity C-Reactive Protein Independent of Aspirin and Atorvastatin in Patients With Stable Coronary Artery Disease. The American Journal of Cardiology. 2007;99(6):805-7.
11. Raju NC, Yi Q, Nidorf M, Fagel ND, Hiralal R, Eikelboom JW. Effect of colchicine compared with placebo on high sensitivity C-reactive protein in patients with acute coronary syndrome or acute stroke: a pilot randomized controlled trial. Journal of Thrombosis and Thrombolysis. 2012;33(1):88-94.
12. Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-Dose Colchicine for Secondary Prevention of Cardiovascular Disease. Journal of the American College of Cardiology. 2013;61(4):404-10.
13. Deftereos S, Giannopoulos G, Angelidis C, Alexopoulos N, Filippatos G, Papoutsidakis N, et al. Anti-Inflammatory Treatment With Colchicine in Acute Myocardial Infarction. Circulation. 2015;132(15):1395-403.
14. Tucker B, Kurup R, Barraclough J, Henriquez R, Cartland S, Arnott C, et al. Colchicine as a Novel Therapy for Suppressing Chemokine Production in Patients With an Acute Coronary Syndrome: A Pilot Study. Clinical Therapeutics. 2019;41(10):2172-81.
15. Arbel Y, Abuzeid W, Rosenson RS, Weisman A, Farkouh ME. Old Drugs for New Indications in Cardiovascular Medicine. Cardiovascular Drugs and Therapy. 2018;32(2):223-32.
16. Colchicine and Spironolactone in Patients With STEMI / SYNERGY Stent Registry (CLEAR-SYNERGY) [Accessed February 26 2020]. Available from: https://clinicaltrials.gov/ct2/show/NCT03048825?term=CLEAR-SYNERGY&draw=2&rank=1.
17. COlchicine for Left VEntricular Remodeling Treatment in Acute Myocardial Infarction (COVERT-MI) [Accessed February 26 2020]. Available from: https://clinicaltrials.gov/ct2/show/NCT03156816?term=COVERT-MI&draw=2&rank=1.
18. Colchicine in Percutaneous Coronary Intervention (Colchicine-PCI) [Accessed February 26 2020]. Available from: https://clinicaltrials.gov/ct2/show/NCT02594111?term=Colchicine-PCI&draw=2&rank=1.
19. Effect of Colchicine in Patients With Myocardial Infarction [Accessed February 26 2020]. Available from: https://clinicaltrials.gov/ct2/show/NCT04218786?term=Effect+of+Colchicine+in+Patients+With+Myocardial+Infarction&draw=2&rank=2.
20. Effect of Colchicine in improvement of myocardial infarction patients undergoing therapeutic intervention [Accessed February 26 2020]. Available from: https://apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20180127038515N1.
21. Evaluation of anti-inflammatory effects of colchicine on the blood flow of heart's vessels and heart's muscle in patients who undergo angioplasty in the acute phase of heart attack [Accessed February 26 2020]. Available from: https://apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20120111008698N23.
PDF downloads: 56
Copyright (c) 2020 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).