Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis.
OBJECTIVE
Effective prevention of recurrent pericarditis remains an important yet elusive goal. Corticosteroid therapy often needs to be continued for a prolonged period and causes severe side effects. We performed a multi-centre all-case analysis to investigate the efficacy of colchicine in preventing subsequent relapses of pericarditis, and addressed the hypothesis that pretreatment with corticosteroids may attenuate the beneficial effect of colchicine.


RESULTS
One hundred and forty published and unpublished cases of patients treated with colchicine after at least two relapses of pericarditis were aggregated from European centres. Of those, 119 were included in the study group. Only 18% of the patients had relapses under colchicine therapy, and 30% after its discontinuation. There were significantly more relapses among male patients after colchicine treatment (36 vs. 17%, P=0.046), and those with previous corticosteroid treatment (43 vs. 13%, P=0.02). Multivariate logistic regression analysis identified previous corticosteroid therapy (OR 6.68, 95% CI: 1.65-27.02) and male gender (OR 4.20, 95% CI: 1.16-15.21) as independent risk factors for recurrence following colchicine therapy.


CONCLUSIONS
Treatment with colchicine is highly effective in preventing recurrent pericarditis, while pretreatment with corticosteroids exacerbates and extends the course of recurrent pericarditis.
Artom
Galit
G
Cardiac Rehabilitation Institute, Sheba Medical Centre, Tel-Hashomer 52621, Israel.
Koren-Morag
Nira
N
Spodick
David H
DH
Brucato
Antonio
A
Guindo
Joseph
J
Bayes-de-Luna
Antoni
A
Brambilla
Giovanni
G
Finkelstein
Yaron
Y
Granel
Brigitte
B
Bayes-Genis
Antoni
A
Schwammenthal
Ehud
E
Adler
Yehuda
Y
D000293:Adolescent; D000305:Adrenal Cortex Hormones; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D003078:Colchicine / Q000627:therapeutic use*; D000075202:Contraindications; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000517:prevention & control*; D011788:Quality of Life; D012044:Regression Analysis; D012307:Risk Factors; D055502:Secondary Prevention; D015983:Selection Bias
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003078:Colchicine