From the Guidelines
Colchicine, when added to ibuprofen, reduces the rate of recurrent pericarditis. The typical regimen involves colchicine 0.5 mg twice daily for patients weighing over 70 kg, or 0.5 mg once daily for those under 70 kg, continued for at least 6 months 1. This combination therapy has shown significant efficacy in preventing recurrences compared to using ibuprofen alone. Colchicine works by inhibiting neutrophil chemotaxis and activity, thereby reducing inflammation in the pericardium. It also interferes with the assembly of the inflammasome, which is involved in the inflammatory cascade that leads to pericarditis.
Key Considerations
- The dose of colchicine should be weight-adjusted, with 0.5 mg twice daily for patients over 70 kg and 0.5 mg once daily for those under 70 kg 1.
- Patients should be monitored for potential side effects of colchicine, which commonly include gastrointestinal symptoms like diarrhea, nausea, and abdominal pain.
- Dose reduction may be necessary in patients with renal or hepatic impairment.
- The combination of colchicine with ibuprofen provides both immediate symptomatic relief from the NSAID component and longer-term prevention of recurrence from the colchicine.
Additional Therapy
In cases of incomplete response to aspirin/NSAIDs and colchicine, corticosteroids may be used, but they should be added at low to moderate doses to aspirin/NSAIDs and colchicine as triple therapy, not replace these drugs, in order to achieve better control of symptoms 1. Corticosteroids at low to moderate doses should be avoided if infections, particularly bacterial and TB, cannot be excluded and should be restricted to patients with specific indications.
Treatment Duration
The treatment duration with colchicine should be at least 6 months for recurrent pericarditis, and CRP should be considered to guide the treatment duration and assess the response to therapy 1.
From the Research
Treatment Options for Recurrent Pericarditis
The following treatments have been added to ibuprofen to reduce the rate of recurrent pericarditis:
- Colchicine: Studies have shown that colchicine, when used in addition to a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, reduces the rate of recurrent pericarditis 2, 3, 4, 5, 6.
Key Findings
- Colchicine has been found to reduce episodes of pericarditis in people with recurrent pericarditis over 18 months follow-up, with a hazard ratio (HR) of 0.37 and a 95% confidence interval (CI) of 0.24 to 0.58 2.
- The use of colchicine has also been associated with a greater chance of symptom relief at 72 hours, with a risk ratio (RR) of 1.4 and a 95% CI of 1.26 to 1.56 2.
- Adverse effects of colchicine were mainly gastrointestinal, including abdominal pain and diarrhea, but the quality of evidence was low due to imprecision 2, 3.
Treatment Recommendations
- Colchicine is recommended as an adjunctive therapy to NSAIDs, such as ibuprofen, for the prevention of recurrent pericarditis 2, 3, 4, 5, 6.
- A 3-month course of colchicine is recommended to relieve symptoms and reduce the risk of recurrence, with continuation for at least 6 months in cases of first recurrence 6.