Colchicine – Treatment of Acute Coronary Syndrome
A study by Gonzalo Martınez et al., published in the Journal of the American Heart Association indicates that colchicine may also be useful for the treatment of heart attacks by reducing cardiac inflammation and the local pro-inflammatory cytokine production.
Colchicine is an alkaloid used to treat gout and Behçet’s disease. This drug with potent anti-inflammatory effects is also often used is used to treat recurrent pericarditis, and familial Mediterranean fever (FMF). Interestingly, colchicine, in the form of the autumn crocus (Colchicum autumnale), has been used as early as 1500 BC to treat joint swelling.
Colchicine is not a pain reliever and cannot be used to treat pain that is not caused by gout or FMF. This drug is in a class of medications called anti-gout agents. It works by stopping the natural processes that cause swelling and other symptoms of gout and FMF.
The drug has several potential mechanisms of action, including reducing the chemotaxis of neutrophils, inhibiting inflammasome signaling, and decreasing the production of cytokines, such as interleukin-1 beta.
When this drug is administered early in the course of COVID-19, these mechanisms could potentially mitigate or prevent inflammation-associated manifestations of the disease.
Recently, the drug has been shown to potentially reduce the risk of cardiovascular events in those with coronary artery disease.
Given that canakinumab has not been approved for cardiovascular prevention, the search for a widely used alternative antiinflammatory treatment that may reduce the risk of atherosclerotic events among patients with coronary artery disease continues.
Colchicine is an inexpensive, orally administered, potent antiinflammatory medication that was initially extracted from the autumn crocus. Its mechanism of action is through the inhibition of tubulin polymerization and microtubule generation and, possibly, effects on cellular adhesion molecules, inflammatory chemokines, and the inflammasome.
In the study published in the Journal of the American Heart Association, the international research team from Australia, Chile, France and the UK found that colchicine given to patients with acute coronary syndrome, the day before a cardiac catheterization, significantly reduced the intracardiac release of interleukin (IL)-1β, IL-18, and IL-6.
These cytokines are major players in atherosclerotic inflammation, and contribute to the atherosclerotic plaque development, progression and destabilization.
This study may suggest a new treatment strategy that could reduce the incidence of new coronary events, which are common after acute coronary syndrome.
An Update
In 2019, Jean-Claude Tardif et al. reported in the The New England Journal of Medicine (NEJM) that among patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo.
Yet, in 2020, et al. reported in Circulation that the addition of this drug to standard medical therapy did not significantly affect cardiovascular outcomes at 12 months in patients with ACS and was associated with a higher rate of mortality.
A recent 2022 meta-analysis aimed to identify the effect of colchicine on myocardial infarction (MI) in patients with gout included three clinical studies with 3012 patients. Colchicine was associated with a decreased risk for myocardial infarction. This meta-analysis concluded that Colchicine was effective in reducing the incidence of MI in patients with gout.
In 2022, et al. in their ‘Colchicine for cardiovascular medicine: a systematic review and meta-analysis‘ concluded: Among 15,569 pooled patients from 21 randomized controlled trials (RCTs), colchicine was superior to placebo in the reduction of cardiovascular events.
In the setting of pericardial diseases, it was associated with a lower risk of recurrent pericarditis. In other studies assessing coronary artery disease patients, colchicine was associated with a reduced risk of major adverse cardiovascular events (MACE) such as myocardial infarction, stroke, cardiovascular death, coronary revascularisation and hospitalization.
Among patients with atrial fibrillation, it was associated with lower rates of recurrence. In the single RCT on heart failure, colchicine was not associated with improved NYHA class.
Source: J Am Heart Assoc, 2015 Aug 24;4(8). pii: e002128. doi: 10.1161/JAHA.115.002128.
Read More: ajp.com.au
