EM PharmD - January 08, 2020
"Role in STEMI
The COLCOT study was a prospective, randomized trial of 4745 patients with a recent MI. Patients were randomized to receive colchicine 0.5 mg daily or placebo within 30 days after MI with the primary outcome of a composite endpoint consisting of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization.
The typical patient enrolled in this study was a 60-year-old male with hypertension who received standard of care treatment (primary PCI) and appropriate secondary prevention drug therapy. Most patients received colchicine or placebo 13 days after the initial MI. The primary outcome occurred in 5.5% of patients receiving colchicine compared to 7.1% receiving placebo (HR 0.77; 95% CI 0.61-0.96; p=0.02). This effect appeared to be driven by the reduction in stroke (HR 0.26, 95% CI 0.1-0.7), and reduction in urgent revascularization (HR 0.5 95% CI 0.31-0.81). More relevant CV related outcomes were not significantly different: CV death (HR 0.84, 0.4-1.52), resuscitated cardiac arrest (HR 0.83, 0.25-2.73), or MI (HR 0.91, 0.68-1.21). From a safety perspective, colchicine was associated with a higher incidence of pneumonia when compared to placebo (p=0.03).
Promising, but still skeptical
While colchicine may hold promise in cardiology, there is sufficient skepticism with this evidence to warrant further study before wide adoption in post-MI care. Aside from the considerably increased cost of care from the drug, it’s not certain what effect the addition to colchicine will have in a larger group of real-world patients."