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Low dose colchicine for secondary prevention in patients with previous atherosclerotic event: a systematic review and meta-analysis of randomised trials
Session:
SESSÃO DE POSTERS 27 - FORMAÇÃO EM CARDIOLOGIA E FARMACOTERAPIA
Speaker:
Rita Barbosa Sousa
Congress:
CPC 2025
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.3 Secondary Prevention
Session Type:
Cartazes
FP Number:
---
Authors:
Rita Barbosa Sousa; Débora da Silva Correia; Rita Amador; Maria Rita Lima; Ana Rita Bello; Daniel A Gomes; João Presume; Marisa Trabulo; Afonso Félix de Oliveira; Jorge Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">INTRODUCTION</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">Colchicine is now recommended for secondary prevention in the latest European Cardiology Society guidelines for managing chronic coronary syndromes. Previously, two major trials and several meta-analyses, which included smaller randomised controlled trials (RCTs), showed that colchicine reduced major cardiovascular events (MACE), though it did not reduce cardiovascular (CV) mortality. Over the past year, three major trials have been published, all demonstrating no significant reduction in cardiovascular events. Two of these trials included patients with ischemic cerebrovascular events, broadening the context for colchicine’s in atherosclerotic disease.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">AIMS</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">To evaluate the efficacy and safety profile of low dose colchicine in secondary prevention among patients with a prior cardiovascular or cerebrovascular event.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">METHODS</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">A systematic search of electronic databases, including Medline and the Cochrane Library, was conducted to identify RCTs comparing colchicine with placebo or usual care in secondary prevention. The primary outcome was a composite measure of CV death, myocardial infarction or stroke. Risk of bias was assessed using the Cochrane quality assessment tool and outcomes were analyzed using an inverse-variance random-effects model.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">RESULTS</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">A total of 11 RCTs, involving </span></span><span style="font-family:"Calibri",sans-serif">30 753 <span style="color:#071320">patients with a follow-up period exceeding one month met the inclusion criteria. </span>Of these, 15 381 patients (50.0%) received colchicine, showing a lower risk of the primary outcome (6.2% vs. 7.2%; relative risk (RR) = 0.80; 95% CI, 0.67–0.94; I² = 56%), reported MACE (7.4% vs. 9.0%; RR = 0.70; 95% CI, 0.57–0.85; I² = 72%) and myocardial infarction (2.2% vs. 2.7%; RR = 0.76; 95% CI, 0.61–0.94; I² = 30%). There is a trend suggesting a potential benefit of colchicine in stroke prevention, but it did not reach statistical significance (2.8% vs. 3.2%; RR = 0.79; 95% CI, 0.61–1.04; I² = 49%). No significant benefit was found for CV mortality (1.3% vs. 1.4%; RR = 0.91; 95% CI, 0.70–1.17; I² = 0%) or all-cause mortality (2.5% vs. 2.6%; RR = 0.98; 95% CI, 0.79–1.21; I² = 39%). The colchicine group reported a higher incidence of gastrointestinal symptoms (12.7% vs. 9.6%; RR = 1.73; 95% CI, 1.25–2.39; I² = 91%). Other adverse events, including hematologic effects (0.4% vs. 0.4%; RR = 0.90; 95% CI, 0.41–1.98; I² = 58%) and infections (2.2% vs. 2.2%; RR = 0.98; 95% CI, 0.74–1.31; I² = 55%) were similar across groups, showing no statistically significant differences. As limitations, we should point out the presence of high heterogeneity across studies and the possibility of publication bias.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">CONCLUSION</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#071320">While colchicine did not reduce CV and all-cause mortality, it still demonstrated significant efficacy in secondary prevention of MACE and myocardial infarction, maintaining a relatively favorable safety profile. High heterogeneity and the possibility of publication bias are important limitations to consider.</span></span></span></span></p>
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