From the Guidelines
Colchicine is recommended as an adjunct to standard anti-inflammatory therapy for the treatment of pericarditis, particularly for recurrent pericarditis, at a dose of 0.5 mg once daily if body weight is <70 kg or 0.5 mg twice daily if it is ≥70 kg, for ≥6 months. This recommendation is based on the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. The guidelines suggest that colchicine improves the response to medical therapy, improves remission rates, and prevents recurrences.
Key Points
- Colchicine should be used in conjunction with aspirin or NSAIDs, which remain the mainstay of therapy for pericarditis 1.
- The dose of colchicine should be weight-adjusted, with 0.5 mg once daily for patients <70 kg and 0.5 mg twice daily for patients ≥70 kg 1.
- Colchicine should be used for at least 6 months to improve remission rates and prevent recurrences 1.
- Corticosteroids may be used in cases of incomplete response to aspirin/NSAIDs and colchicine, but should be added at low to moderate doses and not replace these drugs 1.
Important Considerations
- Colchicine works by inhibiting neutrophil chemotaxis and activity, reducing inflammation in the pericardium 1.
- Common side effects of colchicine include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain 1.
- Colchicine should be avoided in patients with severe renal or hepatic dysfunction and those taking strong CYP3A4 inhibitors 1.
- Dose adjustment is necessary for elderly patients and those with mild to moderate renal impairment 1.
From the Research
Role of Colchicine in Pericarditis Treatment
- Colchicine is effective and safe for the treatment and prevention of recurrent pericarditis, and may serve as the initial mode of treatment, especially in idiopathic cases 2.
- The use of colchicine has been established as a first-line treatment option in acute and recurrent pericarditis, on top of conventional treatment, with a good safety profile and gastrointestinal intolerance being the most common side effect 3.
- Colchicine reduces the incidence of primary pericarditis and recurrent pericarditis, with the number needed to treat for preventing recurrent pericarditis being five 4.
Efficacy of Colchicine in Preventing Recurrent Pericarditis
- Colchicine decreases the recurrence rate in patients with a first episode of acute pericarditis, with recurrence rates at 18 months being 10.7% versus 32.3% 2.
- Colchicine reduces the incidence rate of recurrent pericarditis in patients with both the first episode and recurrent pericarditis, compared with placebo 5.
- Colchicine is superior to placebo in the prevention of post-pericardiotomy syndrome (PPS) at 1 year 5.
Safety and Side Effects of Colchicine
- The most common side effects of colchicine are related to the gastrointestinal system, with diarrhea being the most common adverse event 2, 4.
- Colchicine cessation due to side effects is similar in both treatment and control groups 4.
- Colchicine has a good safety profile, with no severe adverse events observed in clinical trials 3, 4.