Colchicine for cardiovascular therapy: A drug interaction perspective and a safety meta-analysis

Abstract

Objective: In this study, we aimed to overview the drug interactions between colchicine and cardiovascular drugs and performed a meta-analysis to evaluate the safety profile of colchicine in cardiovascular treatment. Methods: The drug interactions between colchicine and cardiovascular drugs were evaluated using Medscape-Drug-Interaction-checker. For safety meta-analysis, a systematic literature search was carried out to retrieve eligible studies. Randomized controlled clinical trials that reported a safety analysis and with at least one-year follow-up period were included into the analysis. Meta-analysis was performed using RevMan 5.4 software provided by the Cochrane Collaboration. Results: Serious drug interactions were found between colchicine and lipid-lowering treatments, including all statins and fibrates; carvedilol among the beta-blockers; non-dihydropyridine calcium channel blockers (verapamil and diltiazem); and amiodarone, digoxin, and quinidine. The safety meta-analysis involved 11,594 patients with coronary disease from four trials. The incidences of gastrointestinal adverse events; hematological adverse events; infection; pneumonia; cancer; myalgia; and abnormal nerve sensations were similar between colchicine and control arm. The incidence of cardiovascular death was lower in the colchicine arm; however, the difference did not reach a significant level [relative risk (RR): 0.71, 95% confidence interval (CI) 0.48–1.05; p=0.09]. The incidence of non-cardiovascular death was significantly higher in the colchicine arm (RR: 1.53, 95% CI 1.10–2.14; p=0.01). The rate of all-cause mortality was similar between the two arms (RR: 1.04, 95% CI 0.61–1.78; p=0.88). Conclusion: Cardiac patients on colchicine therapy should be carefully monitored to avoid the complications of serious drugs interactions. The reported data in the literature were not sufficient to evaluate the common side effects such as gastrointestinal events and myalgia. The higher incidence of non-cardiovascular death cannot be ignored and should be thoroughly investigated in future studies.