Home' Australian Pharmacist : Australian Pharmacist March 2016 Contents Australian Pharmacist March 2016 I © Pharmaceutical Society of Australia Ltd.
Cardiovascular disease is the main cause of death globally. In Australia,
it affects 1.4 million people and about 43,603 deaths are attributed to
CVD. The main pathophysiological mechanism of CVD is the formation of
atherosclerotic plaques. Inflammatory processes are also involved and
have been associated with increased risk of coronary events.
Colchicine is an anti-inflammatory
drug used to treat acute gout. It is also
used to treat other diseases such as
familial Mediterranean fever, Behcet’s
disease, primary biliary cirrhosis and
pericarditis. Low dose colchicine has
been shown to have a benefit in the
treatment and prevention of pericarditis.
Moreover, in patients with increased
risk for cardiovascular events, low dose
colchicine treatment was used in trials
for six months.
Characteristics of the studies
Randomised controlled trials including
cluster and pseudo-randomised
controlled trials comparing colchicine
over a minimum of six months versus
any control in any adult population with
any condition or disease were included
in the review.
Quality of the research
Studies included in the report were
of moderate methodological quality.
Biases such as blinding of participants,
incomplete outcome of data and
selective reporting in some of the
studies were major drawbacks.
The following databases were searched:
Cochrane Central Register of Controlled
Trials (CENTRAL, Issue 1 of 12, 2015),
MEDLINE In-Process & Other Non-
Indexed Citations, (Ovid,1946 to 30 Jan
2015), EMBASE (embase.com 1947 to
15 May 2014) and EMBASE Classic +
EMBASE (Ovid, 1947 to 30 Jan 2015).
A total of 39 trials with 4,992
participants were included in the
review. Of these studies, four included
1,230 participants with specific heart
conditions. The reviewers also found
another five ongoing studies meeting
the inclusion criteria but have not been
The outcome measures included
all-cause mortality, cardiovascular
mortality, myocardial infarction, heart
failure, stroke, and adverse events.
A total of 30 trials had data on all
mortality. The Relative Risk (RR)
for colchicine versus control was
0.94 (95% CI 0.82 to 1.09) which
showed no difference due to the wide
Data on myocardial infarction were
available for six studies including
910 participants. There was a significant
reduction in myocardial infarction
reported by two trials; 652 participants;
RR 0.20, (95% CI 0.07 to 0.57).
There was an increased risk of adverse
events reported in the included studies.
These were mainly gastrointestinal
Data on cardiovascular mortality were
available for seven studies including
1,132 participants. The RR for colchicine
compared with placebo was 0.34 (95% CI
0.09 to 1.21).
Implications for research and
The current results indicate potential
cardiovascular benefits of colchicine and
highlight the need to conduct further
larger trials to reduce the uncertainty
associated with the current evidence.
The current evidence supports the
effectiveness of colchicine in reducing
myocardial infarction but not on the
other outcomes studies. Further studies
investigating various doses of colchicine
and larger number of participants are
needed to confirm the current evidence.
1. Hemkens LG, Ewald H, Gloy VL, et al. Colchicine for
prevention of cardiovascular events. Cochrane Database of
Systematic Reviews 2016, Issue 1. Art. No.: CD011047. DOI:
2. Dalton, Marita, et al. Waist circumference, waist–hip ratio and
body mass index and their correlation with cardiovascular
disease risk factors in Australian adults. Journal of internal
medicine 2003;254(6):555–63 .
3. Go AS, et al. Heart disease and stroke statistics-2014 update.
4. Verma, Subodh, et al. Colchicine in cardiac disease: a
systematic review and meta-analysis of randomized
controlled trials. BMC cardiovascular disorders 2015;15(1):1.
The effectiveness of
colchicine in preventing
BY DR HANAN KHALIL
» EVIDENCE SUMMARIES
The purpose of this evidence summary is to provide
the best available evidence for the effectiveness of
Colchicine in the prevention of cardiovascular events.
For the full review, please refer to Hemkens LG, Ewald
H, Gloy VL, Arpagaus A, Olu KK, Nidorf M, Glinz D,
Nordmann AJ, Briel M. Colchicine for prevention
of cardiovascular events. Cochrane Database of
Systematic Reviews 2016, Issue 1. Art. No.: CD011047.
Dr Hanan Khalil is the Director of the Centre for
Chronic Disease Management, a collaborating centre
of the Joanna Briggs Institute, Faculty of Medicine,
Nursing and Health Sciences, Monash University, and
a reviewer for the consumer group of the Cochrane
Collaboration. Dr Khalil is also the Editor in Chief of the
International Journal of Evidenced Based Health Care.
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