LO099: Colchicine in acute and recurrent pericarditis: a meta-analysis

Abstract

Introduction: Pericarditis is a common disease associated with significant morbidity. In adults with pericarditis, we sought to determine if colchicine, in addition to standard therapies, could reduce the incidence of pericarditis recurrence, shorten the duration of symptoms and minimize adverse effects associated with other therapies. Methods: We followed PRISMA guidelines. We performed an electronic search (February 2015) through MEDLINE, EMBASE, CENTRAL, Web of Science, and Google scholar. Online trial registries were searched and reference lists were handed searched. Our search strategy had no limitations on study design, outcome of interest, hypothesis, language, dates or publication status. Inclusion criteria for selected manuscripts were: RCTs; adults; outpatient therapy; and idiopathic/viral/autoimmune pericarditis etiology. Cohen's unweighted kappa for inter-observer agreement was calculated. Data was extracted using a standardized data collection tool. Following assessment of homogeneity between studies, we performed a meta-analysis using (fixed or random) effect models and report odds ratios (OR) with 95% confidence intervals (CI). We assessed bias using GRADE. Results: We screened 647 titles/abstracts, and selected 34 manuscripts for full review (kappa 0.86, CI 0.76-0.96). 7 manuscripts met all inclusion criteria comprising 1,275 patients. We obtained the following OR with 95% CI: 1) For the overall incidence of recurrence of pericarditis (OR 0.32; CI 0.24-0.42); 2) For recurrent pericarditis at 18-months (OR 0.32; CI 0.23-0.44); 3) For event-free of recurrent pericarditis at 18-months follow-up (OR 3.40; CI 2.46-4.70); 4) For persistent symptoms at 72 hours (OR 0.29; CI 0.21-0.41); and 5) For the overall adverse events rate (OR 1.27; Cl 0.84-1.92). Conclusion: Colchicine reduces the number of pericarditis recurrences and the duration of symptoms in patients with recurrent or acute pericarditis. Unless there are contraindications to its use, colchicine should be prescribed in all cases of uncomplicated pericarditis, along with standard therapy.