What is the role of colchicine in the treatment of pericardial effusion?

Updated: Nov 28, 2018
  • Author: William J Strimel, DO, FACP; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

The routine use of colchicine in combination with conventional therapy is supported by results from the COlchicine for acute PEricarditis (COPE) trial. In this study, 120 patients with a first episode of acute pericarditis (idiopathic, acute, postpericardiotomy syndrome, or connective tissue disease) entered a randomized, open-label trial comparing aspirin treatment alone with aspirin plus colchicine (1-2 mg for the first day followed by 0.5-1 mg daily for 3 mo). [30]

In the study, colchicine reduced symptoms at 72 hours (11.7% vs 36.7) and reduced recurrence at 18 months (10.7% vs 36.7%). Colchicine was discontinued in 5 patients because of diarrhea, but no other adverse events were noted. Importantly, none of the 120 patients developed cardiac tamponade or progressed to pericardial constriction. The ICAP Trial (Investigation on Colchicine for Acute Pericarditis) will provide further information regarding the use of colchicine as first-line therapy. [31]

However, colchine may not be effective for patients with asymptomatic postoperative pericardial effusion. A study involving 149 patients with mild or moderate pericardial effusion on transthoracic echocardiography found no significant difference on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients who received colchicine (n = 74) and those who received placebo (n = 75). [89] The investigators attributed these findings to the likelihood that most of the cases of pericardial effusion were from noninflammatory causes.


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