What medication is used to prevent recurrent pericardial effusion?

From the Guidelines

Colchicine is the primary medication used to prevent recurrent pericardial effusion, with a recommended dose of 0.5 mg twice daily or 0.5 mg daily for patients < 70 kg or intolerant to higher doses, for a duration of at least 6 months. The use of colchicine as an adjunct to aspirin/NSAIDs is supported by the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. According to these guidelines, colchicine therapy of longer duration (> 6 months) should be considered in some cases, according to clinical response 1.

The management of recurrent pericarditis involves a step-wise approach, with aspirin and NSAIDs being the mainstays of treatment, and colchicine being used as an adjunct therapy 1. In cases of corticosteroid-dependent recurrent pericarditis, drugs such as IVIG, anakinra, and azathioprine may be considered in patients not responsive to colchicine 1.

Key points to consider in the management of recurrent pericardial effusion include:

• The use of colchicine as a first-line treatment to prevent recurrences 1
• The importance of monitoring CRP levels to guide treatment duration and assess response to therapy 1
• The need for exercise restriction in patients with recurrent pericarditis, particularly athletes, until symptom resolution and CRP normalization 1
• The potential use of corticosteroids in steroid-dependent or colchicine-resistant cases, with careful tapering to minimize side effects 1

From the Research

Medication for Preventing Recurrent Pericardial Effusion

• Colchicine is a medication that has been used to prevent recurrent pericardial effusion, as evidenced by studies 2, 3, 4, 5.
• The use of colchicine in the treatment of recurrent pericarditis and pericardial effusion has been shown to be effective in reducing the incidence of these conditions 2, 3, 4.
• Colchicine works by inhibiting various leukocyte functions, which helps to depress the action of leukocytes and fibroblasts at the site of inflammation, thereby reducing the risk of recurrent pericardial effusion 2.
• The dosage of colchicine used in these studies varied, but typical dosages ranged from 1-2 mg per day, with treatment durations ranging from several weeks to several months 2, 3, 5.
• The use of colchicine has been shown to be safe and well-tolerated, with few side effects reported in the studies 2, 3, 5.

Efficacy of Colchicine

• The COPPS trial, a multicenter, double-blind, randomized trial, demonstrated the efficacy and safety of colchicine in preventing postpericardiotomy syndrome, postoperative pericardial and pleural effusions, and postoperative atrial fibrillation 5.
• The study found that colchicine significantly reduced the incidence of these conditions, with relative risk reductions ranging from 43.9% to 58% 5.
• The number needed to treat (NNT) to prevent one case of postpericardiotomy syndrome, postoperative pericardial effusion, or postoperative atrial fibrillation ranged from 8 to 11 5.

Clinical Implications

• The use of colchicine may be considered as an alternative to traditional treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, for the prevention of recurrent pericardial effusion 2, 3, 4.
• Further studies are needed to confirm the efficacy and safety of colchicine in this setting and to determine the optimal dosage and treatment duration 5.