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The efficacy and safety of low dose colchicine in atherosclerotic cardiovascular disease - A systematic review and meta-analysis

B. Tucker, William J Tucker, J. Chung, G. A. Figtree, A. Keech, Sanjay Patel

European Journal of Preventive Cardiology, 2025

30,808 participants · 17 citations

Abstract

AIM

Colchicine has recently been approved for the treatment of atherosclerotic cardiovascular disease (ASCVD). Since then, three large trials of colchicine in ASCVD have failed to reach their primary endpoints.

METHOD

A systematic search of PubMed, Embase and Cochrane Central Register of Controlled Trials was performed (PROSPERO registration: CRD42024616378). The primary endpoint of major adverse cardiovascular events (MACE) was defined as a composite of myocardial infarction, stroke and cardiovascular death. The key secondary endpoint of extended MACE (eMACE) was defined as MACE plus coronary revascularisation. Pooled estimates were calculated using a random-effects model and are presented as risk ratio (95% confidence interval).

RESULTS

1624 articles were screened. 12 met inclusion criteria, yet one trial reported zero endpoint events in both arms. As such, 11 trials were included in the meta-analysis, with a total of 1983 primary endpoint events across 30,808 participants. Colchicine was associated with a 17% reduction in the incidence of MACE (0.83 [0.73, 0.95]; p=0.006) and 23% reduction in the incidence of eMACE (0.77 [0.63, 0.94]; p=0.01). This reduction was driven by a lower rate of myocardial infarction (0.78 [0.63, 0.95]; p=0.02) and coronary revascularisation (0.73 [0.55, 0.97]; p=0.03). There were also numerically fewer strokes in the colchicine treated population (0.81 [0.63, 1.04]; p=0.11). Colchicine had no effect on cardiovascular (0.96 [0.79, 1.15]; p=0.64)…

How strong is the evidence?

Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 30,808 participants or records.

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