Colchicine for Recurrent Pericarditis (CORP): A Randomized Trial
Is colchicine safe and effective for the secondary prevention of recurrent pericarditis?
In a prospective, randomized, double-blind, placebo-controlled multicenter trial conducted in Italy, 120 patients with a first recurrence of pericarditis were randomly assigned to receive either placebo or colchicine (1.0-2.0 mg on the first day followed by a maintenance dose of 0.5-1.0 mg/d for 6 months) in addition to conventional treatment. The primary study endpoint was the recurrence rate of pericarditis at 18 months. Secondary endpoints were symptom persistence at 72 hours, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and rate of constrictive pericarditis.
At 18 months, the pericarditis recurrence rate was 24% in the colchicine group and 55% in the placebo group (absolute risk reduction, 0.31; 95% confidence interval [CI], 0.13-0.46; relative risk reduction, 0.56; CI 0.27-0.73; number needed to treat, 3; CI, 2-7). Colchicine reduced the persistence of symptoms at 72 hours (absolute risk reduction, 0.30; CI, 0.13-0.45, relative risk reduction, 0.56; CI, 0.27-0.74), and mean number of recurrences increased the remission rate at 1 week, and prolonged the time to subsequent recurrence. The study groups had similar rates of side effects and drug withdrawal.
The authors concluded that colchicine is safe and effective for secondary prevention of recurrent pericarditis.
Recurrent pericarditis is probably the most common and troublesome complication of acute pericarditis, occurring in 10-30% of patients with a first episode of acute pericarditis; the recurrence rate increases up to 50% after a first recurrence. Colchicine has shown promise for the secondary prevention of recurrent pericarditis in observational studies and in one open-label, single-center, randomized trial. The current trial demonstrated a decrease in the rate of pericarditis recurrence with colchicine use among patients with pericarditis not of malignant or bacterial etiology, supporting its use.
Keywords: Recurrence, Colchicine, Secondary Prevention, Pericarditis, Cardiac Tamponade, Italy
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