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European Heart Journal Advance Access originally published online on March 8, 2005
European Heart Journal 2005 26(7):723-727; doi:10.1093/eurheartj/ehi197
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis

Galit Artom1, Nira Koren-Morag2, David H. Spodick3, Antonio Brucato4, Joseph Guindo5, Antoni Bayes-de-Luna5, Giovanni Brambilla4, Yaron Finkelstein1, Brigitte Granel6, Antoni Bayes-Genis5, Ehud Schwammenthal1 and Yehuda Adler1,*

1Cardiac Rehabilitation Institute, Sheba Medical Centre, Tel-Hashomer 52621, Israel
2Sackler school of Medicine, Tel Aviv University, Israel
3St Vincent Hospital, Worchester, MA, USA
4Department of Medicine Brera, Rheumatology, Niguarda Ca'Granda Hospital, Milan, Italy
5Service of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
6Service de Medicine Interne, Hopital de la Timone, Marseille, France

Received 12 April 2004; revised 8 January 2005; accepted 3 February 2005; online publish-ahead-of-print 8 March 2005.

* Corresponding author. Tel: 972 58 547138; fax: 972 3 5303079. E-mail address: adlery{at}sheba.health.gov.il

See page 631 for the editorial comment on this article (doi:10.1093/eurheartj/ehi045)

Aims Effective prevention of recurrent pericarditis remains an important yet elusive goal. Corticosteroid therapy often needs to be continued for a prolonged period and causes severe side effects. We performed a multi-centre all-case analysis to investigate the efficacy of colchicine in preventing subsequent relapses of pericarditis, and addressed the hypothesis that pretreatment with corticosteroids may attenuate the beneficial effect of colchicine.

Methods and results One hundred and forty published and unpublished cases of patients treated with colchicine after at least two relapses of pericarditis were aggregated from European centres. Of those, 119 were included in the study group. Only 18% of the patients had relapses under colchicine therapy, and 30% after its discontinuation. There were significantly more relapses among male patients after colchicine treatment (36 vs. 17%, P=0.046), and those with previous corticosteroid treatment (43 vs. 13%, P=0.02). Multivariate logistic regression analysis identified previous corticosteroid therapy (OR 6.68, 95% CI: 1.65–27.02) and male gender (OR 4.20, 95% CI: 1.16–15.21) as independent risk factors for recurrence following colchicine therapy.

Conclusion Treatment with colchicine is highly effective in preventing recurrent pericarditis, while pretreatment with corticosteroids exacerbates and extends the course of recurrent pericarditis.

Key Words: Pericarditis • Corticosteroids • Colchicine


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