Colchicine Hastens Resolution and Reduces Recurrence After First Attack of Acute Pericarditis

EBM Focus - Volume 8, Issue 43

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Reference: (N Engl J Med 2013 Oct 17;369(16):1522) (level 1 [likely reliable] evidence)

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.

For more information, see the Acute pericarditis and Colchicine topics in DynaMed.