CORP: Colchicine Prevents Recurrent Pericarditis

August 28, 2011

August 28, 2011 (Paris, France) — Italian researchers have shown that colchicine, when given in addition to conventional therapy, prevents recurrent episodes of pericarditis [1].

Specifically, the study, Colchicine for Recurrent Pericarditis (CORP), looked at the use of the drug during a first recurrence of pericarditis, said Dr Massimo Imazio (Maria Vittoria Hospital, Turin, Italy), who presented the findings during a late-breaking clinical-trial session at the European Society of Cardiology (ESC) 2011 Congress today. The results also are published online in the Annals of Internal Medicine.

"Colchicine appears to be a safe, low-cost drug for rapid symptom relief, improved remission rates at one week, and reduced recurrence after an initial episode of recurrent pericarditis," he commented.

Discussant of the study, Dr Andre Keren (Hadassah Hebrew University Hospital, Jerusalem, Israel), noted that "recurrence is a troublesome and frequent complication of acute pericarditis" and that both CORP and an earlier single center study, CORE, show that low-dose colchicine is effective in preventing recurrences of the disease. "The time has come where colchicine should be more freely used," Keren urged.

Colchicine Halves Rate of Pericarditis Recurrence

Around a third of patients who develop pericarditis will suffer recurrences, Imazio said, noting that CORP is the first multicenter, double-blind randomized trial of colchicine in the secondary prevention of pericarditis and confirms the findings of the earlier CORE study.

The time has come where colchicine should be more freely used.

In the trial, 120 patients with a first recurrence of pericarditis were randomized to either placebo or low-dose colchicine (1 mg twice daily for 24 hours, then 0.5 mg twice daily for six months for those weighing over 70 kg) in addition to conventional treatment--aspirin 800 to 1000 mg or ibuprofen 600 mg orally every eight hours for seven to 10 days as a first choice or prednisone 0.2 to 0.5 mg/kg/day for four weeks as second choice.

The primary end point was recurrence rate at 18 months. Secondary end points included symptom persistence at 72 hours, remission rate at one month, number of recurrences, time to subsequent recurrence, disease-related hospitalization, cardiac tamponade, and constrictive pericarditis.

Colchicine halved the rate of recurrence--24% of those taking colchicine had recurrence compared with 55% of those on placebo (relative risk reduction 56%; p<0.001), and there were also significant reductions in a number of secondary end points among those taking colchicine compared with placebo.

This translates into a number needed to treat (NNT) of only three patients to prevent one recurrence, Imazio said.

The drug was safe in the doses used, he added, with no difference in adverse events between the colchicine and placebo groups.

The results support the use of low-dose colchicine as a first-line adjuvant to standard care in recurrent pericarditis, he said, calling the results "impressive."

He noted, however, that the CORP findings are specific for the population tested--adult patients with a first recurrence of pericarditis, excluding those with bacterial or neoplastic pericarditis and others who may have contraindications to colchicine use--and therefore may not be generalizable to other settings or patient populations, such as children. Also, he noted that use of colchicine for pericarditis is an off-label indication.

Last year at the ESC meeting, Imazio reported that colchicine prevented the development of postpericardiotomy syndrome (PPS) after heart surgery.

Imazio has no conflicts of interest. Disclosures for the coauthors are not available. Keren has no conflicts of interest.