Colchicine therapy in patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

Introduction Inflammation is a substantial mediator of atherosclerosis. Colchicine has anti-inflammatory effects and has been investigated in many randomized controlled trials (RCTs) in patients with coronary artery disease (CAD). Methods We searched PubMed/MEDLINE, Cochrane library, and Embase databases (inception through 28 February 2020) for RCTs evaluating colchicine in CAD patients. The outcomes of interest were major adverse cardiovascular events (MACE), myocardial infarction (MI), all-cause mortality, cardiovascular mortality, and stroke. Estimates were pooled using inverse-variance random-effects model. We reported effect sizes as risk difference (RD) with 95% confidence interval (CI). Results A total of six RCTs with 6154 patients were included. The mean age +/- SD for the patients in the colchicine group was 61.6 +/- 10.8 and control group was 61.5 +/- 10.7 years. At the median follow-up of 3.5 months, use of colchicine in patients with CAD was not associated with statistically significant reduction of MACE (RD -0.032; 95% CI -0.083 to 0.018; P = 0.15; I-2 = 75%; low level of evidence), MI (RD -0.011; 95% CI -0.030 to 0.007; P = 0.16; I-2 = 11.3%; low level of evidence), all-cause mortality (RD -0.001; 95% CI -0.009 to 0.006; P = 0.65; I-2 = 0%; low level of evidence), cardiovascular mortality (RD -0.003; 95% CI -0.010 to 0.004; P = 0.34; I-2 = 0%; low level of evidence), and stroke (RD -0.001, 95% CI -0.005 to 0.004; P = 0.69; I-2 = 0%; very low level of evidence). Conclusion This meta-analysis suggests that colchicine was not associated with a significant decrease in cardiovascular endpoints and mortality in patients with CAD.