A Randomized Trial of Colchicine for Acute Pericarditis

the Internal Medicine Department, St. Vincent Hospital, Worcester, MA (D.H.S.)
New England Journal of Medicine (Impact Factor: 55.87). 08/2013; 369(16):130831233005005. DOI: 10.1056/NEJMoa1208536


Colchicine is effective for the treatment of recurrent pericarditis. However, conclusive data are lacking regarding the use of colchicine during a first attack of acute pericarditis and in the prevention of recurrent symptoms. Methods
In a multicenter, double-blind trial, eligible adults with acute pericarditis were randomly assigned to receive either colchicine (at a dose of 0.5 mg twice daily for 3 months for patients weighing >70 kg or 0.5 mg once daily for patients weighing 70 kg) or placebo in addition to conventional antiinflammatory therapy with aspirin or ibuprofen. The primary study outcome was incessant or recurrent pericarditis. ResultsA total of 240 patients were enrolled, and 120 were randomly assigned to each of the two study groups. The primary outcome occurred in 20 patients (16.7%) in the colchicine group and 45 patients (37.5%) in the placebo group (relative risk reduction in the colchicine group, 0.56; 95% confidence interval, 0.30 to 0.72; number needed to treat, 4; P<0.001). Colchicine reduced the rate of symptom persistence at 72 hours (19.2% vs. 40.0%, P=0.001), the number of recurrences per patient (0.21 vs. 0.52, P=0.001), and the hospitalization rate (5.0% vs. 14.2%, P=0.02). Colchicine also improved the remission rate at 1 week (85.0% vs. 58.3%, P<0.001). Overall adverse effects and rates of study-drug discontinuation were similar in the two study groups. No serious adverse events were observed. Conclusions
In patients with acute pericarditis, colchicine, when added to conventional antiinflammatory therapy, significantly reduced the rate of incessant or recurrent pericarditis. (Funded by former Azienda Sanitaria Locale 3 of Turin [now Azienda Sanitaria Locale 2] and Acarpia; ICAP number, NCT00128453.)

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    ABSTRACT: Introduction Recurrence is a common complication of acute pericarditis, affecting 10–50% of patients after first attack. Steroids have been associated with increased recurrence of pericarditis along with known major side effects. Cardiac MRI (CMR) has been more frequently used to assess pericardial inflammation and guide medical therapy. The aim of our study is to assess whether CMR-guided therapy offers any clinical benefit over standard therapy. Method and results We evaluated 145 consecutive patients who developed recurrence following firstattack of pericarditis and treated with colchicine and NSAIDs. 67 patients treated with medications without CMR (group 1) were compared to 78 patients who had CMR-guided therapy (group 2). Both groups had similar baseline characteristics. All patients used colchicine and NSAID as first line treatment with similar followup period (13 ± 15 vs. 12 ± 13 months, respectively, p = 0.7) (Table 1). Patients ingroup 1 had higher number of steroid pulse therapy (p = 0.03) (defined as prednisone 50 mg orally daily for 10 days then tapered over 4 weeks), and higher overall total milligram of steroid administered as compared to patients in group 2 (p = 0.01). Recurrence rate was lower in (group 2) compared to (group1) (p = 0.001). Etiology of pericarditis was idiopathic in 67% in both groups. There was no significant difference in incidence of constrictive pericarditis, pericardiocentesis, pericardial windows and pericardiectomy among groups (Table 1). Conclusion CMR-guided therapy modulates the management of recurrent pericarditis, which can decrease recurrence rate and the exposure to steroids. Larger and multicenter study is necessary to validate these findings.
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