Long-term secondary prevention with colchicine in patients with CAD: an updated systematic review and meta-analysis.

Abstract

The CLEAR SYNERGY trial failed to demonstrate any benefit of colchicine in patients with acute myocardial infarction (MI). In this meta-analysis of the randomized clinical trials (RCTs) of colchicine in coronary artery disease (CAD), we updated the estimates of effect on cardiovascular events in patients with CAD. We searched for the largest RCTs of colchicine in CAD patients. The effect was assessed in a pooled analysis of individual events such as MI, urgent coronary revascularization (UR), stroke, cardiovascular mortality, and total mortality, for each of these endpoints using hazard ratios (HR) and their 95 % confidence intervals (CI), estimated by the Cox model. Fixed-effects or random-effects models were used. A similar approach was used for the composite of MI, UR, and cardiovascular mortality (MACE 1) and stroke, MI, total mortality (MACE 2). Safety was also assessed. Five studies were selected with a total of 18,656 patients. Colchicine reduced the risk of MI by 21 %, HR 0.79 (95 % CI: 0.68 - 0.92).Its effect was neutral on total and cardiovascular mortality. The composite endpoints MACE 1 and MACE 2 were reduced by colchicine, HR 0.81 (95 % CI: 0.68 - 0.98), and HR 0.88 (95 % CI: 0.79 - 0.98), respectively. There were no differences in non-cardiovascular mortality, cancer, and serious gastrointestinal and infectious events. The benefit of colchicine appears attenuated compared to past analyses, but is still valuable in reducing the risk of MI and the composite of MI, UR, and cardiovascular death. The safety appears reassuring in relation to all serious adverse reactions.