Low-Dose Colchicine Effective for Preventing Ischaemic Stroke and Atherosclerotic Events, Meta-Analysis Reveals

This analysis suggests that in patients with a history of stroke or coronary artery disease, colchicine lowered the incidence of ischaemic strokes and major adverse cardiovascular events (MACE). The treatment demonstrated a consistent effect across important subgroups and did not increase serious safety issues or mortality.

Colchicine, traditionally used to treat gout and familial Mediterranean fever, has garnered attention for its anti-inflammatory properties. Guidelines suggest the use of low-dose colchicine for secondary prevention in cardiovascular disease; however, uncertainties persist regarding its effectiveness for stroke, its efficacy in specific subgroups, and the potential for uncommon yet serious safety outcomes.

Against the above background, Aernoud T.L. Fiolet, Department of Cardiology at University Medical Center Utrecht, the Netherlands, and colleagues conducted a collaborative meta-analysis. Their primary objective was to assess the effectiveness of colchicine in preventing ischaemic strokes and MACE. Additionally, they aimed to provide detailed safety data and examine the efficacy of colchicine in key clinical subgroups.

In the trial-level meta-analysis, the researchers comprehensively searched bibliographic databases and trial registries from inception till May 16, 2024. We included randomized trials assessing the use of colchicine for the secondary prevention of ischaemic stroke and MACE, which encompasses ischaemic stroke, myocardial infarction, coronary revascularization, and cardiovascular death. Secondary outcomes included serious safety events and mortality. A fixed-effect inverse-variance model was employed to calculate a pooled estimate of relative risk (RR).

The following were the key findings of the study:

• The analysis included six trials with a total of 14,934 patients who had a history of stroke or coronary disease.
• Compared to placebo or no colchicine, the use of colchicine led to a 27% reduction in the risk of ischaemic stroke (132 events in the colchicine group versus 186 events in the control group, RR 0.73) and a 27% reduction in MACE (505 events versus 693 events, RR 0.73).
• The effectiveness of colchicine was consistent across key subgroups, including gender, age (below versus above 70), presence of diabetes, and statin use.
• Colchicine was not linked to an increased risk of serious safety outcomes. Hospitalization for pneumonia occurred in 1.5% of patients in the colchicine group compared to 1.5% in the control group (RR 0.99).
• Cancer diagnoses were reported in 3.5% of patients on colchicine versus 3.6% on placebo (RR 0.97).
• Gastrointestinal events were similar, with 2.1% in the colchicine group compared to 1.9% in the control group (RR 1.15).

To conclude, the authors found that in patients with a history of stroke or coronary disease, low-dose colchicine effectively reduced the risk of ischaemic stroke and MACE. These benefits were consistent across key clinical subgroups, and there were no significant increases in other serious safety events or all-cause mortality.

"Our study supports the incorporation of low-dose colchicine into clinical practice for the secondary prevention of stroke and coronary events," they wrote.

Reference:

Fiolet, A. T., Poorthuis, M. H., Opstal, T. S., Amarenco, P., Boczar, K. E., Buysschaert, I., Budgeon, C., Chan, N. C., Cornel, J. H., Jolly, S. S., Layland, J., Lemmens, R., Mewton, N., Nidorf, S. M., Pascual-Figal, D. A., Price, C., Shah, B., Tardif, J., Thompson, P. L., . . . Kelly, P. J. (2024). Colchicine for secondary prevention of ischaemic stroke and atherosclerotic events: A meta-analysis of randomised trials. EClinicalMedicine, 76, 102835. https://doi.org/10.1016/j.eclinm.2024.102835