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European Heart Journal Advance Access published online on March 8, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi197
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received April 12, 2004
Revised January 8, 2005
Accepted February 3, 2005

Clinical research

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

Galit Artom 1, Nira Koren-Morag 2, David H. Spodick 3, Antonio Brucato 4, Joseph Guindo 5, Antoni Bayes-de-Luna 5, Giovanni Brambilla 4, Yaron Finkelstein 1, Brigitte Granel 6, Antoni Bayes-Genis 5, Ehud Schwammenthal 1, and Yehuda Adler 1*

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

* To whom correspondence should be addressed.
Yehuda Adler, E-mail: adlery{at}sheba.health.gov.il


  Abstract

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Methods and results One hundred and forty published and unpublished cases of patients treated with colchicine after at least two relapses of pericarditis were aggregated from European centres.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.

Keywords: Pericarditis; Corticosteroids; Colchicine.
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