This study was limited because 53 patients were excluded due to post-operative complications, non-compliance, or gastrointestinal side effects of treatment. Imazio et al. Both studies enrolled patients in multiple Italian sites. The primary end point of PPS occurred in 35 patients However, there were no significant differences between the colchicine and placebo groups for the secondary end points of post-operative atrial fibrillation The unwanted safety concerns for this trial, with increased risk of gastrointestinal adverse effects, reduced the potential benefits of colchicine in this setting since colchicine reduced the rate of post-operative AF in those who tolerated the drug.
Most of the recent meta-analyses include the same studies and the results are superimposable. In brief, authors conclude that colchicine reduces recurrences in patients with both acute and recurrent pericarditis as well as symptom duration in patients with pericarditis with a slight increase in side effects that are rarely serious.
There is a trend towards a lower incidence rate of complications, such as cardiac tamponade and constrictive pericarditis. In view of the robust clinical efficacy and the high rate of recurrence with standard treatment alone, colchicine is strongly considered a primary therapeutic agent in patients with acute pericarditis in the absence of contraindications.
Primary outcomes of the Cochrane database of systematic reviews modified from ref. In conclusion, over the past three decades, the journey of colchicine for the treatment of pericardial diseases has been long and successful, achieving top indications in clinical guidelines and real world use in day to day clinical practice. Indeed, colchicine has been the only new incorporation into the therapeutic armamentarium for pericardial diseases that entered the clinical realm during the last three decades.
Further issues concerning the long-term usage of colchicine in patients pre-treated with corticosteroids and the role of colchicine with and without the addition of aspirin or NSAIDs in the treatment of acute pericarditis and prevention of recurrences still need to be further elucidated. References are available as supplementary material at European Heart Journal online. Email: docandros bluewin. Oxford University Press is a department of the University of Oxford.
It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents The early years: prospective open-label cohorts — Classical indications and new therapeutic uses. Google Scholar PubMed. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis.
Task Force on the diagnosis management of pericardial diseases of the European Society of Cardiology. Pharmacokinetics and absolute bioavailability of colchicine after i. Prolonged reduction in polymorphonuclear adhesion following oral colchicine.
Plasma kinetics and biliary excretion of colchicine in patients with chronic liver disease after oral administration of a single dose and after long-term treatment. Colchicine prophylaxis in familial Mediterranean fever: reappraisal after 15 years. Long term colchicine treatment in children with familial Mediterranean fever. Deaths from intravenous colchicine resulting from a compounding pharmacy error—Oregon and Washington, Letter regarding article by Imazio et al. Colchicine in addition to conventional therapy for acute pericarditis.
Reversible acute cyclosporine nephrotoxicity induced by colchicine administration. Is myopathy in renal transplant patients induced by cyclosporine or colchicine? Two probable cases of serious drug interaction between clarithromycin and colchicines.
Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency: a retrospective study. Rapid onset of muscle weakness rhabdomyolysis associated with the combined use of simvastatin and colchicine. Fatal toxic myopathy attributed to propofol, methylprednisolone, and cyclosporine after prior exposure to colchicine and simvastatin. Colchicine-induced acute myopathy in a patient with concomitant use of simvastatin. Acute myopathy in a patient with concomitant use of pravastatin and colchicine.
Colchicine biotransformation by human liver microsomes. Identification of CYP3A4 as the major isoform responsible for colchicine demethylation. Colchicine down-regulates cytochrome P 2B6, 2C8, 2C9, and 3A4 in human hepatocytes by affecting their glucocorticoid receptor-mediated regulation.
Effects of colchicine and phenothiazine on biliary excretion of organic anions in rats. Rationale and design of the COPPS trial: a randomised, placebo-controlled, multicentre study on the use of colchicine for the primary prevention of postpericardiotomy syndrome. Investigation on colchicine for acute pericarditis: a multicenter randomized placebo-controlled trial evaluating the clinical benefits of colchicine as adjunct to conventional therapy in the treatment and prevention of pericarditis; study design and rationale.
CORP COlchicine for Recurrent Pericarditis and CORP-2 trials: two randomized placebo-controlled trials evaluating the clinical benefits of colchicine as adjunct to conventional therapy in the treatment and prevention of recurrent pericarditis. Study design and rationale. Intravenous colchicine for treatment of patients with familial Mediterranean fever unresponsive to oral colchicine. Prognosis of idiopathic recurrent pericarditis as determined from previously published reports. Published on behalf of the European Society of Cardiology.
All rights reserved. For permissions please email: journals. Issue Section:. Download all slides. Supplementary data. AddSuppFiles-6 - ppt file. AddSuppFiles-5 - jpg file.
AddSuppFiles-4 - ppt file. AddSuppFiles-3 - jpg file. AddSuppFiles-2 - ppt file. AddSuppFiles-1 - jpg file. View Metrics.
Email alerts Article activity alert. Advance article alerts. New issue alert. Receive exclusive offers and updates from Oxford Academic. More on this topic Clinical characteristics and health-related quality of life of patients with recurrent pericarditis in the United States: findings from a patient survey. Management and outcome of acute and recurrent pericarditis during pregnancy.
Hydroxychloroquine for colchicine-resistant glucocorticoid-dependent idiopathic recurrent pericarditis: an observational prospective study. Treatment of recurrent pericarditis with colchicine.
Related articles in Web of Science Google Scholar. Related articles in PubMed Rod-shaped nintedanib nanocrystals improved oral bioavailability through multiple intestinal absorption pathways.
The Spicy Story of Cannabimimetic Indoles. Citing articles via Web of Science Latest Most Read Most Cited Why are mineralocorticoid receptor antagonists the Cinderella in evidence-based treatment of myocardial infarction complicated with heart failure?
Echocardiography for risk stratification in patients with pulmonary embolism at low risk of death: a response. Population genomic screening of young adults for familial hypercholesterolaemia: a cost-effectiveness analysis.
The optimal strategy for multivessel coronary revascularization. Leadless vs. Looking for your next opportunity? Relief with colchicine.
Usefulness of colchicine in preventing recurrences of pericarditis. Am J Cardiol. Colchicine treatment for recurrent pericarditis. A decade of experience. Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE colchicine for REcurrent pericarditis trial. Arch Intern Med. Colchicine in addition to conventional therapy for acute pericarditis: Results of the colchicine for acute pericarditis COPE trial.
Treatment of recurrent pericarditis with colchicine. Eur Heart J. Ann Intern Med. Imazio M, Adler Y. Heart Fail Rev. Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis. Colchicine for pericarditis: Hype or hope?
Colchicine for the primary and secondary prevention of pericarditis: An update. Ann Pharmacother. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis CORP-2 : A multicentre, double-blind, placebo-controlled, randomised trial.
Prevention of recurrent pericarditis with colchicine in Clin Cardiol. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: A multi-centre all-case analysis.
A randomized trial of colchicine for acute pericarditis. Meurin P, Tabet JY. Colchicine in acute pericarditis: A new standard?
Arch Cardiovasc Dis. Postoperative pericardial effusion and the relation to postpericardiotomy syndrome. Viral illness and postpericardiotomy syndrome. Postpericadiotomy syndrome. Heart Lung. Spodick DH. Traumatic pericardial disease: Accidental, criminal, surgical and biological trauma. In: Spodick DH, editor. The pericardium: A comprehensive textbook. New York: Dekker; Colchicine for the prevention of postpericardiotomy syndrome.
Meta-analysis of randomized trials focusing on prevention of the post-pericardiotomy syndrome. Colchicine for the primary prevention of the postpericardiotomy syndrome. Impact of colchicine on pericardial inflammatory syndromes — An analysis of randomized clinical trials. Int J Cardiol. Rationale and design of the Colchicine for Prevention of the Post-pericardiotomy Syndrome and Post-operative Atrial Fibrillation COPPS-2 trial : A randomized, placebo-controlled, multicenter study on the use of colchicine for the primary prevention of the postpericardiotomy syndrome, postoperative effusions, and postoperative atrial fibrillation.
Am Heart J. Heidecker J, Sahn SA. Echocardiograms frequently are normal in patients with the clinical syndrome of acute pericarditis, unless there is an associated pericardial effusion. The finding of pericardial effusion supports diagnosis, but its absence does not exclude acute pericarditis. Markers of inflammation, such as WBC count, erythrocyte sedimentation rate, and C-reactive protein concentration, are usually elevated.
These findings are nonspecific to pericarditis. Serum cardiac troponin I levels also have been shown to be elevated in some patients. The treatment of acute pericarditis should be guided by the underlying cause. Ninety percent of acute pericarditis cases are idiopathic or viral, making NSAIDs, prednisone, and colchicine the foundations of therapy. NSAID therapy is initiated empirically for idiopathic pericarditis and generally leads to symptom resolution within 2 weeks.
Indomethacin should be avoided in elderly patients and in patients with coronary artery disease, owing to its negative impact on coronary flow; ibuprofen is the preferred NSAID. Corticosteroid therapy has resulted in rapid symptom control; however, it has been linked to higher rates of recurrent pericarditis.
In Dressler syndrome, corticosteroids should be reserved only for refractory symptoms, because these agents can delay myocardial healing. Colchicine is an anti-inflammatory agent that works by inhibiting tubulin polymerization, thereby interfering with migration and phagocytosis and reducing the inflammatory cycle.
For acute pericarditis, colchicine is generally used in combination with other therapies. This agent may be useful in recurrent pericarditis, which is immune-mediated, owing to its ability to disrupt the inflammatory cycle involved in pathogenesis.
TABLE 1 summarizes treatment alternatives and dosing for acute pericarditis. COPE was conducted in adult patients diagnosed with acute pericarditis. Recent Studies: Colchicine for Recurrent Pericarditis CORP was the first prospective, multicenter, double-blind, randomized, placebo-controlled trial investigating the use of colchicine in treating this type of pericarditis.
The Investigation on Colchicine for Acute Pericarditis ICAP was a multicenter, double-blind, randomized trial of adult patients with acute pericarditis. CORP led to the recommendation of colchicine as a first-line agent for the treatment of recurrent pericarditis in the guidelines of the European Society of Cardiology.
Because patients with neoplastic or bacterial pericarditis were excluded from these studies, the results do not apply to these subsets. The optimal duration of colchicine therapy has not been identified, so further clarification is warranted. Pharmacists play a key role within the healthcare system in informing patients, improving their care, and promoting the safe and effective use of medications.
Pharmacists can ensure the safe use of agents used to treat acute pericarditis by educating patients about their medications, recommending appropriate therapies and dose adjustments based on renal function and comorbidities, screening for drug-drug and drug-food interactions, and monitoring for AEs.
For instance, in patients receiving NSAIDs, pharmacists can take the lead in evaluating patients and considering the addition of misoprostol or proton pump inhibitors for prophylaxis against NSAID-related gastrointestinal complications such as ulcers, especially in high-risk patients. In addition, pharmacists should evaluate the need for prevention of glucocorticoid-induced osteoporosis and recommend calcium, vitamin D, and bisphosphonates as indicated.
In terms of colchicine, it is imperative that appropriate dosages be used in underweight patients and that frequent monitoring of possible colchicine AEs be conducted.
0コメント