New role for the old drug Colchicine in coronary artery disease?

Colchicine is a well known drug used in the treatment of acute gouty arthritis, having use in familial Mediterranean fever and acute pericarditis. Two recent studies – COLCOT [1] and LoDoCo2 [2] have demonstrated its use in coronary artery disease. COLCOT trial from Canada was a randomized, double-blind trial involving 4745 patients recruited within 30 days after a myocardial infarction. A composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke or urgent hospitalization for angina leading to coronary revascularization was the primary endpoint of the study. They concluded that among patients with a recent myocardial infarction, colchicine at a dose of 0.5mg daily gave significantly lower risk of ischemic cardiovascular events than placebo.

LoDoCo2 from Australia, was a randomized controlled, double-blind trial in patients with chronic coronary artery disease.  5522 patients were randomized to either colchicine 0.5 mg once daily or placebo. Primary endpoint was a composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization. Composite of cardiovascular death, spontaneous myocardial infarction or ischemic stroke was a key secondary endpoint. This study also demonstrated significantly lower risk of cardiovascular events in the colchicine group. Another evidence supporting the role of inflammation in atherosclerosis and its complications.

References

1. Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, The SHK, Xu XF, Ireland MA, Lenderink T, Latchem D, Hoogslag P, Jerzewski A, Nierop P, Whelan A, Hendriks R, Swart H, Schaap J, Kuijper AFM, van Hessen MWJ, Saklani P, Tan I, Thompson AG, Morton A, Judkins C, Bax WA, Dirksen M, Alings M, Hankey GJ, Budgeon CA, Tijssen JGP, Cornel JH, Thompson PL; LoDoCo2 Trial Investigators. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020 Nov 5;383(19):1838-1847. doi: 10.1056/NEJMoa2021372. Epub 2020 Aug 31. PMID: 32865380.
2. Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, Pinto FJ, Ibrahim R, Gamra H, Kiwan GS, Berry C, López-Sendón J, Ostadal P, Koenig W, Angoulvant D, Grégoire JC, Lavoie MA, Dubé MP, Rhainds D, Provencher M, Blondeau L, Orfanos A, L’Allier PL, Guertin MC, Roubille F. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019 Dec 26;381(26):2497-2505. doi: 10.1056/NEJMoa1912388. Epub 2019 Nov 16. PMID: 31733140.