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Colchicine for Recurrent Pericarditis (CORP): A Randomized Trial
Study Questions:
Is colchicine safe and effective for the secondary prevention of recurrent pericarditis?
Methods:
In a prospective, randomized, double-blind, placebo-controlled multicenter trial conducted in Italy, 120 patients with a first recurrence of pericarditis were randomly assigned to receive either placebo or colchicine (1.0-2.0 mg on the first day followed by a maintenance dose of 0.5-1.0 mg/d for 6 months) in addition to conventional treatment. The primary study endpoint was the recurrence rate of pericarditis at 18 months. Secondary endpoints 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.
Results:
At 18 months, the pericarditis recurrence rate was 24% in the colchicine group and 55% in the placebo group (absolute risk reduction, 0.31; 95% confidence interval [CI], 0.13-0.46; relative risk reduction, 0.56; CI 0.27-0.73; number needed to treat, 3; CI, 2-7). Colchicine reduced the persistence of symptoms at 72 hours (absolute risk reduction, 0.30; CI, 0.13-0.45, relative risk reduction, 0.56; CI, 0.27-0.74), 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.
Conclusions:
The authors concluded that colchicine is safe and effective for secondary prevention of recurrent pericarditis.
Perspective:
Recurrent pericarditis is probably the most common and troublesome complication of acute pericarditis, occurring in 10-30% of patients with a first episode of acute pericarditis; the recurrence rate increases up to 50% after a first recurrence. Colchicine has shown promise for the secondary prevention of recurrent pericarditis in observational studies and in one open-label, single-center, randomized trial. The current trial demonstrated a decrease in the rate of pericarditis recurrence with colchicine use among patients with pericarditis not of malignant or bacterial etiology, supporting its use.
Keywords: Recurrence, Colchicine, Secondary Prevention, Pericarditis, Cardiac Tamponade, Italy
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