Lower-dose colchicine may benefit patients with first recurrence of pericarditis

Colchicine is a safe and effective treatment for patients who have had a first recurrence of pericarditis, according to a recent study published August 28, in the Annals of Internal Medicine.

Pericarditis frequently recurs and is a common complication for about one-third of patients with a first episode of acute pericarditis and up to half of patients with a first recurrence. The authors reported that there is some evidence that colchicine may prevent secondary recurrence. To evaluate the efficacy and safety of colchicine as an adjunct to conventional therapy for the treatment and secondary prevention of recurrent pericarditis, researchers developed the CORP (COlchicine for Recurrent Pericarditis) trial.

This prospective, randomized, double-blind, placebo-controlled, multicenter trial enrolled 120 patients with a first recurrence of pericarditis from 4 general hospitals in Italy. The patients were randomly assigned to either receive placebo or colchicine in addition to conventional treatment with aspirin daily for 6 months. Patients in the treatment group received colchicine, 1.0 mg to 2.0 mg, on the first day, followed by a maintenance dosage of 0.5 to 1.0 mg/d for 6 months. In addition to placebo or colchicines, both groups received conventional treatment with aspirin, 800 mg to 1,000 mg (or ibuprofen, 600 mg) orally every 8 hours for 7 to 10 days, with gradual tapering over 3 to 4 weeks.

The primary study end point was the recurrence rate at 18 months. Secondary end points included symptom persistence at 72 hours, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and rates of constrictive pericarditis.

The recurrence rate at 18 months was 24% in the colchicine group and 55% in the placebo group. Researchers also noted that colchicine significantly reduced the persistence of symptoms at 72 hours (absolute risk reduction, 0.30 [CI, 0.13 to 0.45]; relative risk reduction, 0.56 [CI, 0.27 to 0.74]) and the mean number of recurrences. Colchicine also increased the remission rate at 1 week and prolonged the time to a subsequent recurrence. Gastrointestinal symptoms were the most frequent side effects, occurring in 7% of the patients in both groups.

“The CORP trial confirms the previously shown benefits of colchicine for preventing recurrent pericarditis when used at lower doses by demonstrating similar efficacy and tolerability,” the authors wrote.

However, they caution that the trial addressed the use of colchicine after the first recurrence of pericarditis in adults and not in patients who had multiple recurrences or in children. In addition, the drug is not approved for the prevention of pericarditis in North America or Europe, and its use as such is considered off-label.