CLINICAL QUESTION

Is colchicine safe and effective for the secondary prevention of atherosclerotic cardiovascular disease?

BOTTOM LINE

The systematic review found that in adults with established atherosclerotic cardiovascular disease, colchicine (Colcrys) reduces the risk of the composite outcome of cardiovascular death, myocardial infarction, and stroke (number needed to treat [NNT] = 114). Colchicine increases the risk of hospitalization for gastrointestinal events (number needed to harm [NNH] = 181), however, there is no overall difference in all-cause mortality or other adverse events. Because of these mixed findings, the authors recommend shared decision-making before prescribing colchicine for secondary prevention. (Level of Evidence = 1a)

SYNOPSIS

The investigators searched multiple databases, including PubMed, EMBASE, and the Cochrane Library, for randomized controlled trials that evaluated the efficacy and safety of colchicine for the prevention of recurrent vascular events in adults with atherosclerotic cardiovascular disease. No language restrictions were applied. Three investigators independently assessed individual studies for eligibility and methodologic quality using a standard risk of bias scoring tool. Conflict resolutions occurred via consensus discussion. Nine trials (N = 30,659) met the eligibility criteria with three trials judged to be at a moderate risk of bias.