From the Guidelines
Colchicine is used to treat pericarditis because it effectively reduces inflammation in the pericardium, the sac surrounding the heart, and significantly reduces the risk of recurrence, as recommended by the 2015 ESC guidelines 1. The typical dosing is 0.5 mg once or twice daily, with treatment duration of three months for an initial episode and six months for recurrent cases, as stated in the guidelines 1. For acute pericarditis, colchicine is usually prescribed alongside NSAIDs like ibuprofen or aspirin, with the goal of improving the response to medical therapy, improving remission rates, and preventing recurrences 1. Patients with reduced kidney function or those taking certain medications may need dose adjustments, and colchicine works by inhibiting neutrophil migration and activity, disrupting microtubule formation, and reducing the release of inflammatory mediators 1. This anti-inflammatory action helps resolve pericardial inflammation and significantly reduces the risk of recurrence, which occurs in about 30% of patients without colchicine treatment, as supported by the guidelines 1. Common side effects include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain, which may require dose reduction or discontinuation in some patients, and the guidelines recommend a weight-adjusted dose to minimize these side effects 1. Some key points to consider when using colchicine for pericarditis include:
- The importance of using colchicine as an adjunct to standard anti-inflammatory therapy, such as aspirin or NSAIDs, to improve the response to medical therapy and prevent recurrences 1
- The need for dose adjustments in patients with reduced kidney function or those taking certain medications, to minimize the risk of side effects 1
- The potential for colchicine to be used for longer durations, up to 6 months, in patients with recurrent pericarditis, as recommended by the guidelines 1
- The importance of monitoring patients for signs of recurrence, such as chest pain or fever, and adjusting the treatment regimen as needed, as stated in the guidelines 1.
From the Research
Why Colchicine is Used to Treat Pericarditis
Colchicine is used to treat pericarditis due to its effectiveness in reducing the recurrence rate of the disease. The following points summarize the key findings:
- Colchicine has been shown to be effective in reducing the recurrence rate of pericarditis in patients with a first episode of acute pericarditis 2.
- The use of colchicine as an adjunct to conventional therapy has been found to lead to a clinically important and statistically significant benefit over conventional treatment alone 2.
- Colchicine has been established as a first-line treatment option for acute and recurrent pericarditis, on top of conventional treatment, due to its good safety profile and efficacy in preventing recurrences 3.
- The most common side effects of colchicine are gastrointestinal intolerance, which may account for treatment withdrawal in some cases 3, 4.
Mechanism of Action and Efficacy
The exact mechanism of action of colchicine in pericarditis is not fully understood, but it is thought to involve the inhibition of microtubule polymerization, which leads to a reduction in inflammation and the prevention of recurrence.
- Colchicine has been found to be effective in reducing the incidence of primary pericarditis and recurrent pericarditis, with a number needed to treat of five 4.
- The use of colchicine has been found to lead to a greater chance of symptom relief at 72 hours, and a reduction in the rate of recurrences at 6,12, and 18 months 5.
Safety and Tolerability
Colchicine is generally well-tolerated, with the most common side effects being gastrointestinal intolerance.
- The pooled risk ratio for adverse events was found to be 1.26, with no statistically significant difference between the treatment groups 5.
- Colchicine has been found to be safe and effective in the treatment of recurrent pericarditis, with a good safety profile and minimal risk of serious adverse events 6.