Abstract Body:
Background
Colchicine has shown to reduce major adverse cardiovascular events and stroke among patients with coronary artery disease. However, its efficacy with short and long use and risk of stroke has not been well studied with conflicting results till date.
Objective
We sought to evaluate the short and long term efficacy of Colchicine for prevention of stroke and major adverse cardiovascular events (MACE).
Methods
We performed a systematic literature search on PubMed, EMBASE, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until July 20th, 2024. Odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. Studies were categorized based on followup duration of < 6 months vs ≥ 6 months.
Results
A total of 16 randomized controlled trials with 24967 patients were included (12538 in Colchicine and 12429 in the control group) in the analysis. The mean age of the colchicine intervention group was 61.69 years, and 62 years in the placebo group. Polled analysis of primary outcome shows that colchicine with longer followup (i.e; ≥ 6 months) significantly reduced the risk of stroke by 39% (OR, 0.61(95%CI: 0.39-0.96), however colchicine with shorter followup (i.e;< 6 months) shows comparable risk of stroke compared with placebo (OR, 0.98 (95%CI: 0.82-1.16). Similarly, colchicine reduced the risk of MACE by 34% among patients with long term followup (OR, 0.66(95%CI: 0.53-0.82), but not in short term groups of patients (OR, 0.91(95%CI: 0.05-15.54). However, risk of cardiovascular mortality at long term followup (OR, 0.81 (95%CI: 0.47, 1.39), short term followup (OR, 0.71 (95%CI: 0.40-1.27), and risk of all cause mortality at long term followup (OR, 1.04 (95%CI: 0.67-1.63), and short term followup (0R, 0.74(95%CI:0.50-1.12) was comparable between colchicine and placebo group.

Conclusion
These findings suggest that Colchicine reduced the risk of stroke and MACE at long term followup (≥ 6 months), but not among patients with shorter followup duration. These key findings for the first time shows colchince can be more effictive if used for longer duration among high risk patients .