A systematic literature review of randomised controlled trials evaluating colchicine for cardiovascular prevention: There is an elephant in the room

Alessia Alunno; Francesco Carubbi; Cecilia Martini; Veronica Moronti; Jessica Santilli; Jan W Schoones; Francesco Maria Mariani; Evy Di Ruscio; Piera Altieri; Claudio Ferri

doi:10.1016/j.ejim.2023.12.027

A systematic literature review of randomised controlled trials evaluating colchicine for cardiovascular prevention: There is an elephant in the room

Eur J Intern Med. 2024 Jan 2:S0953-6205(23)00463-6. doi: 10.1016/j.ejim.2023.12.027. Online ahead of print.

Affiliations

¹ University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy. Electronic address: alessia.alunno82@gmail.com.
² University of L'Aquila, Department of Clinical Medicine, Life, Health & Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy.
³ Directorate of Research Policy, Leiden University Medical Center, Leiden, the Netherlands.

PMID: 38171935
DOI: 10.1016/j.ejim.2023.12.027

Abstract

Objectives: To review randomised controlled trials (RCT) investigating colchicine (COL) for cardiovascular (CV) prevention in patients at high to very high CV risk aiming to extract data that could be useful in rheumatology practice.

Methods: A systematic search of multiple databases according to the PICO framework was performed from inception to April 3, 2023. Three researchers independently screened abstracts/titles and reviewed full texts reviewed. Data extraction was performed using a pilot-tested data extraction form.

Results: A total of 14,096 references were retrieved by the search and 30 articles, describing 28 RCTs, were included in the review (Total number of patients 16,795, of which 8,463 randomised to COL; dose 0.5-2 mg/day, treatment duration 1day-29 months). Only one of the 28 RCTs provided clear information on whether patients with rheumatic diseases (more specifically gout) were enrolled in the study cohorts and previous use of COL was an exclusion criterion only in 14 (50 %) RCTs. Previous therapy with glucocorticoids and/or non-steroidal anti-inflammatory drugs and/or immune suppressive therapies was an exclusion criterion only in 9 (32 %) RCTs.

Conclusion: Our results highlight the need to redefine the eligibility criteria as well as the reporting of results in future RCTs in order to minimise bias or previous exposure to COL and also obtain data that could be useful in rheumatology practice.

Keywords: Cardiovascular prevention; Cardiovascular risk; Colchicine; Rheumatic disease.