Li Hoi-Ying, Cheriyan Joseph, Chan Tsz-Kwan, Yiu Kai-Hang, Tse Hung-Fat, Wilkinson Ian B, Chan Yap-Hang
Department of Medicine, School of Clinical Medicine, The University of Hong Kong, K1927C, Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong SAR, China.
Department of Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Am J Cardiovasc Drugs. 2025 Sep 1. doi: 10.1007/s40256-025-00743-y.
Colchicine has been incorporated into major clinical guidelines for the secondary prevention of cardiovascular disease (CVD). However, recent randomized trials have presented contradictory results.
We aimed to synthesize the current evidence on colchicine in secondary CVD protection, using a cumulative-dose approach.
We conducted a meta-analysis incorporating all randomized controlled trials (RCTs) globally. RCTs directly comparing colchicine versus placebo/standard care for the secondary prevention of cerebrovascular or coronary vascular disease were included. Odds ratios (OR) were derived for the primary outcome, defined as the prospective occurrence of major adverse cardiovascular events (MACE). Secondary outcomes included mortality, individual components of MACE, C-reactive protein, and adverse effects.
In total, 14 RCTs including 31,397 participants were included. Colchicine significantly reduced MACE (OR 0.80; 95% confidence interval [CI] 0.68-0.94) in both acute atherothrombotic CVD and all CVD (OR 0.72; 95% CI 0.60-0.86) and resulted in significant prospective reductions in C-reactive protein. The threshold effect was apparent, with a protective benefit of colchicine against MACE at higher cumulative exposure ≥ 90 mg-days (OR 0.66; 95% CI 0.52-0.84). Colchicine resulted in no differences in cardiovascular or non-cardiovascular mortality.
Colchicine significantly reduces MACE in both acute atherothrombotic and all CVD across multiple ethnicities, with a threshold protective effect that clinically corresponds to treatment with 0.5 mg daily for at least 6 months. Importantly, there was no signal of increased all-cause mortality.
PROSPERO identifier no. CRD420251003142.
秋水仙碱已被纳入心血管疾病（CVD）二级预防的主要临床指南。然而，近期的随机试验呈现出相互矛盾的结果。
我们旨在采用累积剂量法综合目前关于秋水仙碱在CVD二级预防中的证据。
我们进行了一项纳入全球所有随机对照试验（RCT）的荟萃分析。纳入了直接比较秋水仙碱与安慰剂/标准治疗用于脑血管或冠状动脉疾病二级预防的RCT。主要结局定义为主要不良心血管事件（MACE）的前瞻性发生，得出比值比（OR）。次要结局包括死亡率、MACE的各个组成部分、C反应蛋白和不良反应。
总共纳入了14项RCT，涉及31397名参与者。秋水仙碱在急性动脉粥样硬化血栓形成性CVD和所有CVD中均显著降低MACE（OR 0.80；95%置信区间[CI] 0.68 - 0.94），并导致C反应蛋白显著前瞻性降低。阈值效应明显，在累积暴露量≥90毫克 - 日时，秋水仙碱对MACE有保护作用（OR 0.66；95% CI 0.52 - 0.84）。秋水仙碱在心血管或非心血管死亡率方面无差异。
秋水仙碱在多种族的急性动脉粥样硬化血栓形成性和所有CVD中均显著降低MACE，具有阈值保护作用，临床上相当于每日服用0.5毫克至少6个月。重要的是，没有全因死亡率增加的迹象。
PROSPERO标识符编号：CRD420251003142。
