According to research published early online in the Annals of Internal Medicine, colchicine is safe and effective for the secondary prevention of recurrent pericarditis.

The prospective, double-blind, placebo-controlled multicentre trial involved 120 patients with a first recurrence of pericarditis. In addition to conventional treatment, patients were randomised to receive either placebo or colchicine, 1.0 to 2.0 mg on the first day, followed by a maintenance dose of 0.5 to 1.0 mg/day, for 6 months. The primary study end point was the recurrence rate at 18 months. Secondary end points were symptom persistence at 72 hours, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and rate of constrictive pericarditis.

The following results were reported:

• At 18 months, the recurrence rate was 24% in the colchicine group and 55% in the placebo group (absolute risk reduction, 0.31 [95% CI, 0.13 to 0.46]; relative risk reduction, 0.56 [CI, 0.27 to 0.73]; number needed to treat, 3 [CI, 2 to 7]).

• Colchicine also reduced the persistence of symptoms at 72 hours (absolute risk reduction, 0.30 [CI, 0.13 to 0.45]; relative risk reduction, 0.56 [CI, 0.27 to 0.74]) and mean number of recurrences, increased the remission rate at 1 week, and prolonged the time to subsequent recurrence.

• The study groups had similar rates of side effects and drug withdrawal.

The authors conclude that “Current guidelines recommend colchicine dosages of 2 mg/day for 1 to 2 days, followed by a maintenance dose of 1 mg/day. The CORE and COPE trials used a maintenance dose of 0.5 mg twice daily, which was reduced to 0.5 mg/day in patients weighing less than 70 kg; thus, lower doses may be equally effective but have a lower rate of side effects. The CORP trial confirms the previously shown benefits of colchicine for preventing recurrent pericarditis when used at lower doses by demonstrating similar efficacy and tolerability”, although it is unclear whether these findings apply to patients who suffer multiple recurrences or suffer from pericarditis of neoplastic or bacterial causes”.