The clinical benefits of anti-inflammatory treatment with colchicine are consistent irrespective of the history and timing of prior acute coronary syndrome (ACS), according to a study published in the Journal of the American College of Cardiology.
In this study, researchers investigated the risk for major adverse cardiovascular events based on prior ACS status in the Low-Dose Colchicine 2 (LoDoCo2) trial, with the objective to determine whether the effects of colchicine are consistent in patients with no prior, recent, or very remote ACS, compared with placebo. The LoDoCo2 trial was a randomized, controlled, double-blind trial initiated in 2014 and completed in 2020 that evaluated colchicine 0.5 mg given orally once daily compared with placebo for the prevention of cardiovascular events. A total of 5522 patients had been randomly assigned to receive placebo (n=2760) or colchicine 0.5 mg (n=2762). The primary efficacy endpoint was the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven revascularization.
The effects of colchicine compared with placebo on these risks were consistent in patients with no prior ACS (incidence 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR], 0.81; 95% CI, 0.52-1.27) and in those with prior ACS (incidence 2.4 vs 3.4 events per 100 person-years; HR, 0.67; 95% CI, 0.54-0.82) (P for interaction =.43).
The reduction of the primary endpoint by colchicine compared with placebo was also consistent across the subgroups of patients with prior ACS: recent ACS (incidence 2.4 vs 3.3 events per 100 person-years; HR, 0.75; 95% CI, 0.51-1.10), remote ACS (incidence 1.8 vs 3.2 events per 100 person-years; HR, 0.55; 95% CI, 0.37-0.82), and very remote ACS (incidence 3.0 vs 4.3 events per 100 person-years; HR, 0.70; 95% CI 0.51-0.96; P for interaction =0.59).
Limitations of this study include the influence of random variation and the inability to detect a difference between patients with no prior ACS and prior ACS due to the small group sizes in the subgroup analyses of the LoDoCo2 trial.
“The benefits of colchicine are consistent irrespective of history and timing of prior ACS, thereby highlighting the importance of compliance with long-term secondary prevention therapies, including the use of anti-inflammatory therapy,” the researchers concluded.
Tjerk S, Opstal J, Aernoud T, et al. Colchicine in patients with chronic coronary disease in relation to prior acute coronary syndrome. J Am Coll Card. 2021;78(9):859-866.