Acute pericarditis is a common self-limiting illness which usually has few sequelae.  However, in a small proportion of patients, pericarditis can become recurrent making treatment more challenging.  The use of colchicine to treat acute pericarditis and prevent recurrence has been a topic of increasing interest in recent years. In this multicentre, double-blind trial, adults with acute pericarditis were randomly assigned to receive either colchicine (at a dose of 500 mcg twice daily for 3 months for patients weighing >70 kg or 500 mcg once daily if ≤70 kg) or placebo in addition to conventional anti-inflammatory therapy (high dose aspirin or ibuprofen). A total of 240 patients diagnosed on clinical history, imaging and ECG criteria were randomised in a 1:1 fashion to either colchicine or placebo and followed for a median of 18 months. The primary outcome w, defined as incessant or recurrent pericarditis, occurred in 20 patients (16.7%) in the colchicine group and 45 patients (37.5%) in the placebo group (RR reduction in the colchicine group, 0.56; 95% CI, 0.30 to 0.72; NNT, 4; P<0.001). In addition to the primary outcome, benefits of colchicine therapy included a reduced rate of symptom persistence at 72 hours (19.2% vs. 40.0%, P=0.001), fewer recurrences per patient (0.21 vs. 0.52, P=0.001), a lower hospitalization rate (5.0% vs. 14.2%, P=0.02) and a higher  remission rate at 1 week (85.0% vs. 58.3%, P<0.001).  Adverse event rates were similar in the two study groups.

Conclusions:

In patients with acute pericarditis, the addition of colchicine to conventional anti-inflammatory therapy significantly reduces symptom persistence and recurrent pericarditis.   This well conducted trial confirms prior findings of nonrandomized and open label trials in support of colchicine for acute pericarditis.

• Imazio M, Brucato A, Cemin R, Ferrua S, Maggiolini S, Beqaraj F, Demarie D, Forno D, Ferro S, Maestroni S, Belli R, Trinchero R, Spodick DH and Adler Y. A Randomized Trial of Colchicine for Acute Pericarditis. N Engl J Med. 2013 Aug 31. [Epub ahead of print]