EfficacyandsafetyofcolchicineforpericarditispreventionSystematicreviewandmeta-analysisTopics:PericardialDiseaseAuthors:MassimoImazio,AntonioBrucato,DavideForno,SilviaFerro,RiccardoBelli,RitaTrinchero,YehudaAdler-Heart2012;98:1078-1082.doi:10.1136/heartjnl-2011-301306.HeartEditor’schoiceBackgroundRecurrentpericarditishasbeenreportedin25%to50%ofcases(1,2),anditisoftenthemosttroublesomeandcommoncomplicationofpericarditis(3).Recurrencesareoftencauseofreadmissionsandrepetitionofdiagnostictests.Thuspreventionofrecurrencesisamajortherapeuticgoaltoimprovethequalityoflifeofpatientsandreducemanagementcosts.Empiricanti-inflammatorytherapiesaremainstayofmedicaltherapy,buthavenotbeenproventobeefficaciousforthepreventionofrecurrences,withthepossibleexceptionofcolchicine(4-6).Shareonlinkedin1AimandmethodsAsystematicreviewwasperformedtoassesstheefficacyandsafetyofcolchicineforpericarditisprevention.Randomisedclinicaltrialsonpharmacologicalpreventionofpericarditiswereincluded.PotentiallyrelevantstudiespublisheduptoDecember2011weresearchedinBioMedCentral,theCochraneCollaborationDatabaseofRandomisedTrials(CENTRAL),ClinicalTrials.gov,EMBASE,GoogleScholar,MEDLINE/PubMed,andScopus.ThePubMedsearchwasperformedwiththeterm‘pericarditis’and‘colchicine’.Recent(2005orlater)conferenceproceedingsfromtheAmericanHeartAssociation,AmericanCollegeofCardiology,andtheEuropeanSocietyofCardiologywereelectronicallyormanuallysearched.Searcheswerenotlimitedbylanguage,sex,orage.Inaddition,referencesofretrievedstudieswerescannedforadditionalunpublishedstudies.MainresultsFromtheinitialsampleof127citations,fivecontrolledclinicaltrialswerefinallyincluded(795patients)andarereportedinthefollowingtable.Threestudiesweredouble-blindrandomisedcontrolledtrials(7-9),andtwostudieswereopen-labelrandomisedcontrolledtrials(1,2).Trialsfollowedpatientsforameanof13months.Meta-analyticpoolingshowedthatcolchicineusewasassociatedwithareducedriskofpericarditisduringfollow-up(RR0.40,95%CI0.30to0.54)eitherforprimaryorsecondarypreventionwithoutasignificanthigherriskofadverseeventscomparedwithplacebo(RR1.22,95%CI0.71to2.10),butmorecasesofdrugwithdrawals(RR1.85,95%CI1.04to3.29).Gastro-intestinalintoleranceisthemostfrequentsideeffect(meanincidence8%),butnosevereadverseeventswererecorded.CommentsAtpresent,thisisthefirstcomprehensivemeta-analysisonthistopic,includingallpublishedclinicaltrialsuptoDecember2011.Therearesomelimitationstobeacknowledged.Someoftheincludedtrialswereopenlabel(1,2),whichmighthaveintroducedbias;howeverfindingsweresimilarinopen-labelandplacebo-controlledtrials(7-9).Moreoveralltrialshaveindependentblindedoutcomeassessmentwithveryloworabsentparticipantdropout,thusindicatingstudiesofhighquality.Anadditionalpotentiallimitationisthatpotentiallyheterogeneouspopulations(idiopathic,viral,postoperativepericarditisaswellaspericarditisrelatedtoasystemicinflammatorydisease)havebeenincluded,howeverthesametreatmentandpreventivestrategiesareadoptedandrecommendedforsuchpatients,thatareheterogeneousforetiologybuthomogenousforpericarditismedicaltherapy.Bacterialandneoplasticpericarditishasbeenexcludedbecauserequiringspecifictreatments.ConclusionInconclusion,thepresentmeta-analysisprovidesastrongerevidencebasefortheuseofcolchicineinpatientswithpericarditis,asoutlinedinpreviousrecommendationsoncolchicineuseinthe2004guidelinesonthemanage...