From the Guidelines
To prevent reaccumulation of pericardial effusion, colchicine is recommended as an adjunct to standard anti-inflammatory therapy, without a loading dose and using weight-adjusted doses, to improve the response to medical therapy, improve remission rates, and prevent recurrences. The use of colchicine, as outlined in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1, is a key component in the management of recurrent pericarditis, which can help prevent the reaccumulation of pericardial effusion. Some key points to consider when using colchicine include:
- Using weight-adjusted doses (i.e., 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
- Adding colchicine to standard anti-inflammatory therapy, such as aspirin or NSAIDs
- Avoiding the use of corticosteroids as a first-line treatment, unless there are specific indications, such as systemic inflammatory diseases or post-pericardiotomy syndromes In addition to colchicine, other treatments, such as intrapericardial instillation of sclerosing agents, may be considered in certain cases, but the use of colchicine as an adjunct to standard anti-inflammatory therapy is a recommended approach to prevent reaccumulation of pericardial effusion, as supported by the 2015 ESC guidelines 1.
From the Research
Prevention of Pericardial Effusion Reaccumulation
- Colchicine can be used to prevent the reaccumulation of pericardial effusion, as it has been shown to be effective in reducing the number of pericarditis recurrences in patients with recurrent pericarditis or acute pericarditis 2, 3, 4, 5.
- The use of colchicine as an adjunctive therapy to non-steroidal anti-inflammatory drugs (NSAIDs) has been found to be effective in preventing further recurrences of pericarditis 2, 6, 5.
- Colchicine has been found to be safe and well-tolerated, with the most common side effect being gastrointestinal intolerance, which can be controlled by dose reduction or temporary discontinuation 6, 5.
- The evidence suggests that colchicine can be used as a first-line treatment for acute and recurrent pericarditis, and as an alternative to NSAIDs and corticosteroids in patients with chronic pericardial effusion 3, 4.
Key Findings
- A systematic review and meta-analysis of controlled clinical trials found that colchicine was effective in reducing the risk of recurrent pericarditis, compared with standard treatment 4.
- A study published in the Cochrane database of systematic reviews found that colchicine reduced episodes of pericarditis in people with recurrent pericarditis over 18 months follow-up 2.
- Another study found that colchicine led to a greater chance of symptom relief at 72 hours, and reduced the subsequent risk of recurrences 2, 6.