Colchicine Treatment for Recurrent Pericarditis

TLDR

Recurrent pericarditis occurs in 15–32 % of acute cases, its cause is often unknown, and no single prevention strategy is universally accepted. This review evaluates the efficacy and safety of colchicine for preventing recurrent pericarditis. Several small studies and a multicenter trial of 51 patients used colchicine after conventional therapy failure to prevent recurrence. Colchicine reduced relapses over up to 10 years of follow‑up and appears promising as an initial treatment, particularly for idiopathic cases.

Abstract

Background —The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. The optimal method for prevention has not been fully established; accepted modalities include nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressive agents, and pericardiectomy. Methods and Results —Based on the proven efficacy of colchicine therapy for familial Mediterranean fever (recurrent polyserositis), several small studies have used colchicine successfully to prevent recurrence of acute pericarditis after failure of conventional treatment. Recently, we reported the results from the largest multicenter international study on 51 patients who were treated with colchicine to prevent further relapses and who were followed up for ≤10 years. Conclusions —In light of new trial data that have accumulated in the past decade, we review the evidence for the efficacy and safety of colchicine for the prevention of recurrent episodes of pericarditis. Clinical and personal experience shows that colchicine may be an extremely promising adjunct to conventional treatment and may ultimately serve as the initial mode of treatment, especially in idiopathic cases.