A Green Light for Colchicine to Treat Acute Pericarditis

Although some experts have recommended the use of colchicine for acute pericarditis, the recommendation has not been based on strong clinical-trial evidence. To address this gap in knowledge, investigators conducted the randomized, double-blind, ICAP trial at five centers in Italy. They assigned 240 patients with a first episode of acute pericarditis to receive colchicine (0.5 mg twice/day for patients weighing >70 kg and 0.5 daily for those weighing ≤70 kg) or placebo for 3 months. All patients were treated with anti-inflammatory agents, mostly aspirin or ibuprofen.

The primary endpoint, incessant or recurrent pericarditis during 18-month follow-up, occurred significantly less frequently in the colchicine group than in the placebo group (17% vs. 38%; relative risk, 0.56; 95% confidence interval, 0.30–0.72). Also, fewer patients in the colchicine group had persistent symptoms at 72 hours (19% vs. 40%; P=0.001). The remission rate at 1 week was higher in the colchicine group than in the placebo group (85% vs. 58%; P<0.001). Adverse-event rates were similar in the two groups.