Colchicine, an antiinflammatory drug used for decades to treat gout, was recently approved to prevent CVD events in patients with established CAD or multiple CAD risk factors. Approval was based on the LoDoCo2 trial
where 5522 patients with stable CAD were randomized to colchicine 0.5 mg
once daily or placebo. After a median follow-up of 29 months, a composite outcome of cardiovascular events (MI, CVD death, stroke, revascularization) occurred in 6.8% of the colchicine group and 9.6% of the placebo group (difference 2.8%, p<0.001). A similar study ( COLCOT trial
| N=4745) had comparable findings in patients with recent MI (5.5% vs 7.1%, difference 1.6%, p=0.02).
Colchicine had a modest effect on CVD in the LoDoCo2 and COLCOT trials, reducing the absolute risk of CVD events over 2 - 3 years by 1 - 3%. It had no significant effect on mortality in either trial, and noncardiovascular death was higher in colchicine-treated patients in the LoDoCo2 trial (1.9% vs 1.3%, HR 1.51 95%CI [0.99 - 2.31]); the reason for this is unclear, as there were no apparent trends in the individual causes of death. Colchicine side effects, including diarrhea, were similar to placebo, and an increased risk of myopathy from combining colchicine with statins - a common drug interaction warning - was not observed.
Colchicine for CVD prevention may be a logical option for certain high-risk CVD patients, particularly those with gout; however, the increased risk of noncardiovascular deaths in the LoDoCo2 trial is concerning. The 0.5 mg dose, which has been given the trade name Lodoco, is not available yet, but the 0.6 mg dose is widely prescribed and has a cheap generic.