Patients who suffer recurrent pericarditis differ from the larger population who incur an initial acute pericarditis, since the former often are burdened with an immune-modulated dysfunction (e.g., familial Mediterranean fever) and the latter includes a large number of diverse infectious etiologies (bacterial and viral). Guidelines have provided some support for the role of colchicine in recurrent pericarditis based primarily on small clinical trials and expert opinion. An open-label trial in acute pericarditis also supported a role for colchicine, but no large, randomized, double-blind trial has confirmed this experience.

Imazio et al report on data from a multicenter, placebo-controlled trial of colchicine in acute pericarditis (n = 240). The primary outcome was “incessant” pericarditis (failure to remit) or recurrent pericarditis. Colchicine or placebo was administered in addition to traditional treatment of pericarditis, and was dosed according to body weight (0.5 mg/d if < 70 kg, 1.0 mg/d if > 70 kg).

The primary outcome occurred 44% less often in the colchicine treatment group, and colchicine was successful for both components (improving remission rates and reducing recurrences).

Source: Imazio M, et al. A randomized trial of colchicine for acute pericarditis. N Engl J Med 2013;369:1522-1528.