Colchicine as First-Choice Therapy for Recurrent Pericarditis

TLDR

Pericarditis often recurs after conventional therapy, and colchicine has shown benefit in refractory cases, yet no trial has evaluated it as first‑line treatment for the initial recurrence. To assess the safety and efficacy of colchicine added to conventional therapy for the first episode of recurrent pericarditis. In a prospective, randomized, open‑label trial, 84 patients with a first recurrent pericarditis episode were assigned to aspirin alone or aspirin plus colchicine (1–2 mg first day, then 0.5–1 mg/d for 6 months), with prednisone used when aspirin was contraindicated, and recurrence rate was the primary endpoint. Colchicine significantly reduced recurrence (24 % vs 50.6 % at 18 months, P = 0.02, NNT = 4) and early symptom persistence (10 % vs 31 %, P = 0.03), with no serious adverse events, and prior steroid use was an independent risk factor for recurrence.

Abstract

Colchicine seems to be a good drug for treating recurrences of pericarditis after conventional treatment failure, but no clinical trial has tested the effects of colchicine as first-line drug for the treatment of the first recurrence of pericarditis.A prospective, randomized, open-label design was used to investigate the safety and efficacy of colchicine therapy as adjunct to conventional therapy for the first episode of recurrent pericarditis. Eighty-four consecutive patients with a first episode of recurrent pericarditis were randomly assigned to receive conventional treatment with aspirin alone or conventional treatment plus colchicine (1.0-2.0 mg the first day and then 0.5-1.0 mg/d for 6 months). When aspirin was contraindicated, prednisone (1.0-1.5 mg/kg daily) was given for 1 month and then was gradually tapered. The primary end point was the recurrence rate. Intention-to-treat analyses were performed by treatment group.During 1682 patient-months (mean follow-up, 20 months), treatment with colchicine significantly decreased the recurrence rate (actuarial rates at 18 months were 24.0% vs 50.6%; P = .02; number needed to treat = 4.0; 95% confidence interval 2.5-7.1) and symptom persistence at 72 hours (10% vs 31%; P = .03). In multivariate analysis, previous corticosteroid use was an independent risk factor for further recurrences (odds ratio, 2.89; 95% confidence interval, 1.10-8.26; P = .04). No serious adverse effects were observed.Colchicine therapy led to a clinically important and statistically significant benefit over conventional treatment, decreasing the recurrence rate in patients with a first episode of recurrent pericarditis.