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CARDIOLOGY

Colchicine for the Primary and Secondary Prevention of Pericarditis: An Update

Clinical Pharmacy Specialist, St. Paul's Hospital, Department of Pharmacy, Vancouver, British Columbia, Canada

Glen J Pearson, PharmD FCSHP

Co-Director, Cardiac Transplant Clinic; Medical Co-Director/Director of Research, Cardiovascular Risk Reduction Clinic; Associate Professor of Medicine, Division of Cardiology University of Alberta, Edmonton, Alberta, Canada

Sheri L Koshman, PharmD

Assistant Professor of Medicine, Division of Cardiology, University of Alberta; Clinical Pharmacotherapy Practitioner, Alberta Health Services, Edmonton

Reprints: Dr. Koshman, Division of Cardiology, University of Alberta, 220 College Plaza, Edmonton, AB T6G 2C8, Canada, fax 780/492-6059, sheri.koshman{at}ualberta.a

OBJECTIVE: To review the efficacy and safety of colchicine as primary and secondary prophylaxis for pericarditis.

DATA SOURCES: We searched MEDLINE, EMBASE, PubMed, BIOSIS Previews, International Pharmaceutical Abstracts, Web of Science, and CENTRAL for controlled studies from database inception date to July 2009. Search terms included colchicine, pericarditis, and postpericardiotomy syndrome (PPS).

STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, controlled trials investigating the use of colchicine in preventing pericarditis were included. Data extracted included design, inclusion criteria, demographics, interventions, background therapy, and pericarditis-related clinical outcomes.

DATA SYNTHESIS: Data were synthesized qualitatively, given variable study designs. Three trials were identified. A single trial examining primary prevention evaluated the use of colchicine versus placebo for preventing PPS in patients undergoing cardiopulmonary bypass grafting. No significant reduction in PPS was found. Two studies examined secondary prevention of pericarditis, comparing colchicine plus aspirin versus aspirin alone. One study examined using these comparators to treat a first episode of pericarditis. After 3 months, there was a significant reduction in recurrent pericarditis with colchicine plus aspirin (11.7% vs 33%; p = 0.009). Another study examined this same regimen in recurrent pericarditis, finding a significant reduction in recurrence after 6 months (21% vs 45%; p = 0.02).

CONCLUSIONS: Despite limitations in study designs, current evidence suggests a role for colchicine in the secondary prophylaxis for recurrent pericarditis. The evidence for use of colchicine as primary prophylaxis in PPS is indeterminate; therefore, colchicine cannot be recommended routinely. While colchicine should be recommended for the prevention of recurrent pericarditis, questions regarding the optimal regimen and long-term safety profile need to be further elucidated.

Key Words: acute pericarditis, colchicine, postpericardiotomy syndrome, recurrent pericarditis, relapsing pericarditis

Published Online, November 10, 2009. www.theannals.com, DOI 10.1345/aph.1M234