Colchicine therapy safe, effective for prevention of recurrent pericarditis

Colchicine therapy, an effective anti-inflammatory agent for gout, is a promising treatment for preventing recurrent pericarditis. However, some patients have discontinued its use because of gastrointestinal intolerance, according to a report published online for the American Journal of Health-System Pharmacy, which will appear in the August 1 edition.

Andrew Smith, PharmD, BCPS, and Judy Eun, a PharmD student at the University of Missouri-Kansas City School of Pharmacy, reviewed the literature, including two meta-analyses and five clinical trials involving the use of colchicine for primary and secondary pericarditis prevention. Patients who received colchicine had a reduced risk of recurrent pericarditis.

Pericarditis-inflammation of the pericardium surrounding the heart-occurs in approximately 0.1% of hospitalized patients and accounts for 5% of all emergency hospitalizations due to nonischemic chest pain. It has also been reported that one quarter to one half of patients experience recurrent pericarditis in 18 to 20 months post-discharge, the authors noted.

In one of the clinical trials, Imazio and colleagues reported in 2011 the use of colchicine with prednisone and aspirin or ibuprofen for the treatment and prevention of pericarditis. Patients in this double-blind study, who also received a loading dose of 1 to 2 mg of colchicine and a maintenance dose of 0.5 to 1 mg daily for 6 months, had a reduced risk of recurrent pericarditis over 18-month follow-up compared with patients who only received prednisone with aspirin or ibuprofen (24% vs. 55%, respectively). Imazio concluded that dosages of 0.5 to 1 mg daily of colchicine was safe and effective to be used as first-line therapy. Both groups experienced similar side effects, however, gastrointestinal intolerance was the most common among patients receiving colchicine, Imazio noted.

In a study published last year, Imazio and colleagues undertook another double-blind study of patients undergoing an initial episode of acute pericarditis without a loading dose of colchicine. Patients were randomized to a maintenance dose of 0.5 to 1 mg daily for 3 months plus prednisone and aspirin or ibuprofen in the treatment group. Incessant or recurrent pericarditis was significantly lower in the group receiving maintenance colchicine compared with the placebo group only receiving prednisone and aspirin or ibuprofen (16.7% vs. 87.5%, respectively). The colchicine-treated group also had a lower rate of hospitalization associated with pericarditis than the placebo group (5.0% vs. 14.2%, respectively). In this study, glucocorticoid use was noted as an independent risk factor for recurrent pericarditis.

“This evidence discussed in [our] article demonstrates that colchicine is highly effective in preventing both initial and recurrent episodes of pericarditis,” Smith and Eun noted.

“In the United States, colchicine is available only as a 0.6-mg tablet, and no published studies have evaluated this dose for the treatment of pericarditis. Therefore, a loading dose of 1.2 mg and a low maintenance dose (0.6 mg once or twice daily) would be reasonable,” they said. “However, careful consideration of maintenance doses that exceed 1 mg is warranted due to the possibility of gastrointestinal adverse effects.”