What is the duration of colchicine treatment for pericarditis?

From the Guidelines

Colchicine for pericarditis should be prescribed for at least 3 months for acute first episodes and 6 months for recurrent pericarditis, with a dose of 0.5-0.6 mg once or twice daily, depending on patient weight. The treatment duration may vary based on the patient's response to therapy and the presence of any underlying conditions that may affect the treatment outcome 1.

Key Considerations

• The dose of colchicine should be adjusted based on patient weight, with lower doses (0.5 mg once daily) recommended for patients weighing less than 70 kg 1.
• Colchicine should be used cautiously in patients with kidney or liver impairment, and dose adjustments may be necessary in these cases 1.
• The treatment should be monitored by a healthcare provider, who can adjust the duration based on clinical response and inflammatory marker levels 1.
• Colchicine works by reducing inflammation in the pericardium by inhibiting neutrophil chemotaxis and activity, and side effects may include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain 1.

Treatment Duration

• For acute first episodes, colchicine is usually given for 3 months 1.
• For recurrent pericarditis, treatment often extends to 6 months, sometimes with a gradual tapering approach to prevent relapse 1.
• In some cases, colchicine therapy of longer duration (> 6 months) may be considered, according to clinical response 1.

Guideline Recommendations

• The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline recommends colchicine 0.5-0.6 mg once or twice daily for 3 months for persistent/late pericarditis symptoms 1.
• The 2015 ESC guidelines recommend colchicine 0.5 mg twice daily or 0.5 mg daily for patients < 70 kg or intolerant to higher doses, for 6 months, as an adjunct to aspirin/NSAIDs 1.

From the Research

Duration of Colchicine Treatment for Pericarditis

• The optimal duration of colchicine treatment for pericarditis is not explicitly stated in the provided studies, but the treatment regimens and follow-up periods can provide some insight 2, 3, 4, 5, 6.
• A study published in 2014 found that colchicine reduced episodes of pericarditis in people with recurrent pericarditis over 18 months of follow-up 3.
• Another study from 2005 reported that only 18% of patients had relapses under colchicine therapy, and 30% after its discontinuation, suggesting that colchicine may need to be continued for an extended period to maintain its efficacy 4.
• A 2024 study found that patients treated with colchicine had a lower incidence of recurrences and a longer event-free survival over a median follow-up of 25.3 months 6.
• The treatment duration may vary depending on the individual patient's response to therapy and the presence of any underlying conditions that may affect the efficacy of colchicine 5.

Factors Influencing Treatment Duration

• Previous corticosteroid therapy has been identified as a risk factor for recurrence following colchicine therapy, which may impact the treatment duration 4.
• Male gender has also been associated with a higher risk of recurrence after colchicine treatment, which may influence the treatment strategy 4.
• The use of colchicine in combination with other medications, such as aspirin or NSAIDs, may also affect the treatment duration and efficacy 3, 5.

Safety and Efficacy

• Colchicine has been shown to be safe and efficacious in reducing recurrences of pericarditis, with mild side effects reported in some studies 3, 6.
• The efficacy of colchicine in preventing recurrent pericarditis has been demonstrated in several studies, with a significant reduction in recurrence rates observed in patients treated with colchicine 3, 4, 6.