# Colchicine Hastens Resolution and Reduces Recurrence After First Attack of Acute Pericarditis

 

 

      EBM Focus - Volume 8, Issue 43 

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Reference: ([N Engl J Med 2013 Oct 17;369(16):1522](http://www.ncbi.nlm.nih.gov/pubmed/23992557?dopt=Abstract)) ([level 1 \[likely reliable\] evidence](https://dynamed.ebscohost.com/content/LOE))

The first attack of acute pericarditis often has a viral cause, while recurrent disease is theorized to be immune-mediated. Colchicine has been shown to speed recovery and reduce the risk of further recurrence in patients with recurrent pericarditis ([Ann Intern Med 2011 Oct 4;155(7):409](http://www.ncbi.nlm.nih.gov/pubmed/21873705?dopt=Abstract&holding=caugamlib)), but its efficacy for the first attack of acute pericarditis has not been previously established. The ICAP trial compared colchicine vs. placebo in 240 patients with a first episode of acute pericarditis.

Patients (mean age 52 years) with their first episode of acute pericarditis were randomized to colchicine 0.5 mg (twice daily if > 70 kg \[154.3 lbs\] or once daily if ≤ 70 kg) vs. placebo for 3 months. All patients also had conventional treatment with aspirin or ibuprofen for 3-4 weeks, or prednisone for patients with contraindications for NSAIDs. The primary outcome was incessant or recurrent pericarditis during follow-up. Incessant disease was defined as persistent symptoms or no symptom-free period > 6 weeks. Recurrent disease was defined as a second episode of pericarditis following a symptom-free period > 6 weeks.

Mean follow-up was 22 months. The incidence of incessant or recurrent pericarditis was 16.7% with colchicine vs. 37.5% with placebo (p <0.001, NNT 5), and remission rates at 1 week were 85% with colchicine vs. 58.3% with placebo (p < 0.001, NNT 4). Colchicine was also associated with reduced persistence of symptoms at 72 hours (19.2% vs. 40%, p = 0.001, NNT 5), and reduced risk of pericarditis-related hospitalization during follow-up (5% vs. 14.2%, p < 0.001, NNT 4). There were no significant differences in rates of adverse events, and no serious adverse events occurred in either group.

For more information, see the [Acute pericarditis](http://web.ebscohost.com/dynamed/detail?sid=f5f00eb7-8947-48b2-a84f-05138830dddc%40sessionmgr13&vid=1&hid=21&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=115401) and [Colchicine ](http://web.ebscohost.com/dynamed/detail?sid=2f455ecd-70aa-495e-ab2c-b8b308a97471%40sessionmgr10&vid=1&hid=21&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=233251)topics in DynaMed.