Anti-Inflammatory Treatment With Colchicine in Stable Chronic Heart Failure: A Prospective, Randomized Study

Study Questions:

What is the efficacy of a 6-month course of anti-inflammatory treatment with colchicine in improving functional status of patients with stable chronic heart failure (CHF)?

Methods:

Patients with stable CHF were randomly assigned to colchicine (0.5 mg twice daily) or placebo for 6 months. The primary endpoint was the proportion of patients achieving at least one-grade improvement in New York Heart Association (NYHA) class. Kaplan-Meier analysis was used to calculate mean free from hospital stay for heart failure survival, and the two groups were compared with the use of the log-rank test.

Results:

Two hundred sixty-seven patients were available for final evaluation of the primary endpoint: its rate was 11% in the control group and 14% in the colchicine group (odds ratio, 1.40; 95% confidence interval, 0.67-2.93; p = 0.365). The rate of the composite of death or hospital stay for heart failure was 9.4% in the control group, compared with 10.1% in the colchicine group (p = 0.839). The changes in treadmill exercise time with treatment were insignificant and similar in the two groups (p = 0.938). C-reactive protein and interleukin-6 were both significantly reduced in the colchicine group (–5.1 mg/L and –4.8 pg/ml, respectively; p < 0.001 for both, compared with the control group).

Conclusions:

The authors concluded that anti-inflammatory treatment with colchicine in patients with stable CHF did not affect in any significant way patient functional status or the likelihood of death or hospital stay for HF.

Perspective:

This prospective, randomized study reports that treatment with colchicine in patients with stable CHF, although effective in reducing inflammatory biomarker levels, does not affect in any significant way patient functional status (in terms of NYHA class or objective exercise tolerance), and had a neutral effect on the rate of death or hospital stay for HF. A minimal favorable effect of treatment on left ventricular dimensions was observed, but this was not translated into functional improvement. A useful result of the present study is the demonstration of safety of this dose of colchicine in patients with CHF, and is reassuring for patients with CHF who need treatment with colchicine for traditional indications. However, there does not appear to be a role of colchicine for improving functional status of patients with stable CHF.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Heart Transplant

Keywords: Exercise Tolerance, Heart Diseases, Colchicine, Interleukin-6, Heart Failure, Stroke Volume, Heart Ventricles, Heart Transplantation, Length of Stay, Exercise Test


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