Abstract Body: Introduction: Colchicine, an anti-inflammatory medication, has demonstrated significant benefits in reducing inflammation and decreasing subsequent vascular events in patients with acute coronary syndrome and myocardial infarction (MI). This has prompted interest in its potential role in secondary prevention of vascular events in individuals who have experienced a stroke or transient ischemic attack (TIA). This abstract explores the evidence supporting colchicine's efficacy and safety in this context.
Methods: We searched PubMed, Cochrane, and Embase databases for randomized controlled trials investigating the effect of colchicine in patients who experienced stroke or TIA of non-cardioembolic origin. Our primary outcomes were any new vascular event (a composite of stroke, TIA, MI, or vascular death) or ischemic stroke. We also assessed the incidence of relevant side effects. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were pooled using a random-effects model.
Results: Two studies were included with a total of 11,487 patients. Colchicine did not reduce vascular events after ischemic stroke or TIA both in long term (RR 0.91; 95% CI 0.79 to 1.05; p = 0.18; I2= 23%) (HR 0.92; 95% CI 0.80 to 1.04; p = 0.18; I2= 0%) and short term (RR 0.83; 95% CI 0.56 to 1.23; p = 0.35; I2= 64%) compared with placebo. There was also no significant advantage in the reduction of recurrence of ischemic stroke in the colchicine group (RR 0.90; 95% CI 0.74 to 1.09; p = 0.28; I2= 44%) (HR 0.91; 95% CI 0.75 to 1.10; p = 0.31; I2= 40%). There were no unforeseen side effects in the Colchicine group (RR 3.78; 95% CI 1.52 to 9.40; p= 0.001; I2= 91%).
Conclusion: Colchicine did not prevent recurrent vascular events or ischemic strokes in patients after a non-cardioembolic stroke or TIA in a large sample size of greater than 11,000 patients. Further well-designed randomized controlled trials are needed to conclusively determine its efficacy and safety in this context. Nevertheless, the early data does not seem to indicate that it will provide benefit to this target population.