Colchicine Hastens Resolution and Reduces Recurrence After First Attack of Acute Pericarditis
EBM Focus - Volume 8, Issue 43
The first attack of acute pericarditis often has a viral cause, while recurrent disease is theorized to be immune-mediated. Colchicine has been shown to speed recovery and reduce the risk of further recurrence in patients with recurrent pericarditis (Ann Intern Med 2011 Oct 4;155(7):409), but its efficacy for the first attack of acute pericarditis has not been previously established. The ICAP trial compared colchicine vs. placebo in 240 patients with a first episode of acute pericarditis.
Patients (mean age 52 years) with their first episode of acute pericarditis were randomized to colchicine 0.5 mg (twice daily if > 70 kg [154.3 lbs] or once daily if ≤ 70 kg) vs. placebo for 3 months. All patients also had conventional treatment with aspirin or ibuprofen for 3-4 weeks, or prednisone for patients with contraindications for NSAIDs. The primary outcome was incessant or recurrent pericarditis during follow-up. Incessant disease was defined as persistent symptoms or no symptom-free period > 6 weeks. Recurrent disease was defined as a second episode of pericarditis following a symptom-free period > 6 weeks.
Mean follow-up was 22 months. The incidence of incessant or recurrent pericarditis was 16.7% with colchicine vs. 37.5% with placebo (p <0.001, NNT 5), and remission rates at 1 week were 85% with colchicine vs. 58.3% with placebo (p < 0.001, NNT 4). Colchicine was also associated with reduced persistence of symptoms at 72 hours (19.2% vs. 40%, p = 0.001, NNT 5), and reduced risk of pericarditis-related hospitalization during follow-up (5% vs. 14.2%, p < 0.001, NNT 4). There were no significant differences in rates of adverse events, and no serious adverse events occurred in either group.