The role of colchicine in Coronary Artery Disease (CAD) has been debated, particularly given neutral findings in some acute coronary syndrome (ACS) trials and favorable outcomes in chronic coronary syndrome. This systematic review and meta-analysis published in the Clinical Pharmacology and Therapeutics examined whether colchicine efficacy and safety differ by clinical presentation.

Twenty randomized trials including 21,486 patients (65.4% with ACS) were analyzed. The primary endpoints were major adverse cardiovascular events (MACE) and serious adverse events (SAEs). Secondary endpoints included all-cause death, cardiovascular death, myocardial infarction (MI), any revascularization, stroke, serious infections or sepsis, and gastrointestinal adverse events. All analyses included an interaction term for clinical presentation. Sensitivity analyses explored heterogeneity.

Colchicine reduced MACE (incidence rate ratio [IRR] 0.70; 95% confidence interval [CI] 0.55–0.87) without increasing SAEs. Significant reductions were observed for myocardial infarction (IRR 0.81; 95% CI 0.70–0.94) and any revascularization (IRR 0.71; 95% CI 0.51–0.99). Gastrointestinal adverse events were more frequent with colchicine (IRR 1.68; 95% CI 1.23–2.28). No statistically significant interaction by clinical presentation was observed for any endpoint. A significant interaction was noted for drug dosage and for the relationship with the COVID-19 pandemic.

Colchicine use in patients with CAD was associated with reduced MACE compared with control without significantly increasing SAEs, although gastrointestinal adverse events were more frequent. No interaction by clinical presentation was observed.