Abstract
Purpose
There has been recent interest in the role of colchicine in cardiovascular diseases,
given the implication of inflammation in the pathogenesis of atherothrombosis. This
systematic review assessed the role of colchicine in preventing primary or secondary
stroke/transient ischemic attack (TIA) in an adult population.
Methods
Four databases were electronically searched: MEDLINE, EMBASE, CENTRAL (Cochrane Central
Register of Controlled Trials), and OpenGrey. Studies were eligible if they reported
stroke or TIA incidence as a primary/secondary end point, or as an adverse event.
Only case–control studies, cohort studies, and randomized controlled trials (RCTs)
were eligible. The primary end point was a pooled estimate using relative risk ratios
(RRs) with 95% CIs. Two-sided P values were considered significant if P < 0.05. Statistical heterogeneity was assessed by using the Cochrane Q statistic
and the Higgin’s I2 statistic. An a priori decision was made to conduct a subgroup analysis based on
study type.
Findings
A total of 5 studies were eligible for inclusion: 4 RCTs and 1 cohort study. There
were 77 reported stroke/TIA events of a combined 2170 patients. Pooling all studies,
stroke incidence was lower in the colchicine versus non-colchicine users (RR, 0.37;
95% CI, 0.22–0.62; P = 0.0002). There was no statistical heterogeneity (χ2 = 2.72; df = 4; P = 0.61; I2 = 0%). Pooling 4 RCTs as determined a priori, there was no significant effect of
colchicine on stroke incidence (RR, 0.61; 95% CI, 0.17–2.17; P = 0.57). Results of the single cohort study suggested that colchicine reduced stroke
incidence (RR, 0.33; 95% CI, 0.19–0.59; P = 0.0002).
Implications
Colchicine has a potential protective benefit in both primary and secondary stroke/TIA
incidence. Current data are inconclusive, likely due to the small sample sizes of
available RCTs. Large-scale pragmatic RCTs are required to provide robust evidence
in this domain.
Keywords
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Article info
Publication history
Published online: March 01, 2019
Accepted:
February 4,
2019
Received in revised form:
January 30,
2019
Received:
November 20,
2018
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier Inc. All rights reserved.
