TY - JOUR
T1 - Colchicine in Stable Coronary Artery Disease
AU - Fiolet, Aernoud T.L.
AU - Nidorf, Stefan M.
AU - Mosterd, Arend
AU - Cornel, Jan H.
N1 - Funding Information:
The conception of this manuscript was done without financial support from any funding agency or grant. The authors are involved in scientific research supported by grants from the ZonMw (The Netherlands Organisation for Health Research and Development), the Netherlands Heart Foundation , the Australian National Health and Medical Research Council and generic pharma. JHC takes part in the steering committee of the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS).
Funding Information:
The conception of this manuscript was done without financial support from any funding agency or grant. The authors are involved in scientific research supported by grants from the ZonMw (The Netherlands Organisation for Health Research and Development), the Netherlands Heart Foundation, the Australian National Health and Medical Research Council and generic pharma. JHC takes part in the steering committee of the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS).
Publisher Copyright:
© 2018
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Purpose: Disease management of stable coronary artery disease consists of controlling hemostasis and lipid regulation. No treatment strategies preventing plaque erosion or rupture are yet available. Cholesterol crystal–induced inflammation leading to plaque destabilization is believed to be an important factor contributing to plaque instability and might well be amenable to treatment with anti-inflammatory drugs. Colchicine has anti-inflammatory properties with the potential to address both the direct and indirect inflammatory mechanisms in the plaque. Methods: A literature search was performed in MEDLINE (PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials, as well as in the clinical trial registries, to identify finished and ongoing clinical studies on colchicine in stable coronary artery disease. Findings: Preclinical findings of colchicine in stable coronary artery disease have shown protective effects on surrogate outcomes, such as myocardial infarction size and postangioplasty restenosis. Retrospective cohort studies in patients with gout report a lower incidence of combined cardiovascular outcomes in those treated with colchicine. Thus far, one prospective, randomized clinical trial has provided evidence on a possible protective effect of colchicine in stable coronary artery disease. Meta-analysis of trials of colchicine in multiple cardiovascular diseases revealed a decrease in myocardial infarction with varying levels of evidence. Currently, 5 major clinical trials involving >10,000 patients are recruiting patients, all focusing on major cardiovascular outcomes. Implications: The body and quality of evidence regarding the efficacy of colchicine for secondary prevention of stable and acute phases of coronary artery disease will be greatly expanded in the upcoming years, providing less biased and more accurate effect estimates. If colchicine's anti-inflammatory characteristics translate to improved event-free cardiovascular survival, this relatively safe, low-cost, and well-known drug may become the third pillar (next to lipid regulation and platelet inhibition) in the medical management of stable coronary artery disease.
AB - Purpose: Disease management of stable coronary artery disease consists of controlling hemostasis and lipid regulation. No treatment strategies preventing plaque erosion or rupture are yet available. Cholesterol crystal–induced inflammation leading to plaque destabilization is believed to be an important factor contributing to plaque instability and might well be amenable to treatment with anti-inflammatory drugs. Colchicine has anti-inflammatory properties with the potential to address both the direct and indirect inflammatory mechanisms in the plaque. Methods: A literature search was performed in MEDLINE (PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials, as well as in the clinical trial registries, to identify finished and ongoing clinical studies on colchicine in stable coronary artery disease. Findings: Preclinical findings of colchicine in stable coronary artery disease have shown protective effects on surrogate outcomes, such as myocardial infarction size and postangioplasty restenosis. Retrospective cohort studies in patients with gout report a lower incidence of combined cardiovascular outcomes in those treated with colchicine. Thus far, one prospective, randomized clinical trial has provided evidence on a possible protective effect of colchicine in stable coronary artery disease. Meta-analysis of trials of colchicine in multiple cardiovascular diseases revealed a decrease in myocardial infarction with varying levels of evidence. Currently, 5 major clinical trials involving >10,000 patients are recruiting patients, all focusing on major cardiovascular outcomes. Implications: The body and quality of evidence regarding the efficacy of colchicine for secondary prevention of stable and acute phases of coronary artery disease will be greatly expanded in the upcoming years, providing less biased and more accurate effect estimates. If colchicine's anti-inflammatory characteristics translate to improved event-free cardiovascular survival, this relatively safe, low-cost, and well-known drug may become the third pillar (next to lipid regulation and platelet inhibition) in the medical management of stable coronary artery disease.
KW - anti-inflammatory drugs
KW - clinical trials
KW - colchicine
KW - coronary artery disease
KW - drug rediscovery
KW - myocardial infarction
KW - Plaque, Atherosclerotic/drug therapy
KW - Coronary Artery Disease/drug therapy
KW - Humans
KW - Gout/drug therapy
KW - Secondary Prevention
KW - Randomized Controlled Trials as Topic
KW - Anti-Inflammatory Agents/therapeutic use
KW - Colchicine/therapeutic use
KW - Myocardial Infarction/drug therapy
KW - Inflammation/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85055905761&partnerID=8YFLogxK
U2 - 10.1016/j.clinthera.2018.09.011
DO - 10.1016/j.clinthera.2018.09.011
M3 - Review article
C2 - 30396516
AN - SCOPUS:85055905761
SN - 0149-2918
VL - 41
SP - 30
EP - 40
JO - Clinical Therapeutics
JF - Clinical Therapeutics
IS - 1
ER -