José Luis López Sendón
Cardiologist at La Paz Hospital and researcher at IdiPAZ (Madrid)
This is a detailed review of studies analyzing the effect of colchicine versus placebo in patients with cardiovascular disease. It is not the first meta-analysis on this topic, but Cochrane reviews are renowned for their quality and impartiality, making them a valuable resource for scientists, drug regulatory agencies, and physicians in general.
Several recent meta-analyses have addressed this topic—the usefulness of low-dose colchicine in secondary prevention of cardiovascular disease—and this one corroborates previous findings: in secondary prevention of cardiovascular disease, administering low-dose colchicine reduces myocardial infarction and stroke compared to control groups receiving a placebo. No increase in adverse effects was observed. It was not shown to reduce mortality, which diminishes the significance of the results.
What this review brings to the table is the reliability of the data analysis using Cochrane methods. It does not offer any novel conclusions and I believe it will have few implications. Its greatest asset is the Cochrane Review's prestige.
[Regarding potential limitations] The reasons why some studies yielded good results and others did not are not discussed. Furthermore, there are three limitations I would like to point out:
Complexity of the inflammatory process. The benefit of colchicine in this population is attributed primarily to its anti-inflammatory effect. It is well established that inflammation, associated with virtually any cardiovascular risk factor and any infection such as the flu, poor dental health, and others, has a direct impact on the progression of atherosclerosis and cardiovascular disease. However, studies with different anti-inflammatory drugs for cardiovascular prevention have yielded negative results or unacceptable side effects, except for colchicine.
Dosage. In all studies, colchicine was administered at a fixed dose throughout the study's observation period. It is highly likely that over several months, the degree of inflammation will vary, with periods of very low or very high inflammatory activity. We need new studies that consider patient selection and dose adjustment according to the degree of inflammation at any given time.
Funding difficulties. Colchicine is the Cinderella of the anti-inflammatory world: it has proven efficacy and potentially better results, but lacks resources for research and promotion of its use. The future of research in this field currently rests in the hands of a relatively small group of scientists who do not give up in the face of difficulties. And they need public funding to continue their research.