Colchicine Use and Risk of Stroke Recurrence in Acute Non-Cardiogenic Ischemic Stroke Patients: A Systematic Review and Meta-analysis
Abdullah Abid Raja1, Hassan Waseem2, Jamir Pitton Rissardo3, Zain abideen4, Sania Aimen5, Ana Leticia Fornari Caprara3, Vishnu Byroju3
1Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan, 2Allama Iqbal Medical College, Lahore, Pakistan, 3Cooper University Hospital, New Jersey, United States, 4King Edward Medical University, Lahore, Pakistan, 5Quetta Institute of Medical Sciences, Pakistan
Objective:
To evaluate the efficacy and safety of long-term colchicine use in preventing stroke recurrence in acute non-cardiogenic ischemic stroke patients.
Background:
Anti-inflammatory therapy with colchicine has been shown to prevent vascular recurrence in coronary artery disease. In contrast to coronary artery disease, which is primarily driven by atherosclerosis, non-cardioembolic acute ischemic stroke has multiple underlying causes, including atherosclerosis, small vessel disease, and unknown etiology.
Design/Methods:
Databases like PubMed, Embase, and Cochrane were searched till September 2024. Risk ratios (RR) with 95% confidence intervals (CI) were pooled for the dichotomous outcomes under the random effects model on Review Manager 5.4.1. The primary outcome was ischemic stroke recurrence. Secondary outcomes were overall stroke risk (ischemic and non-ischemic), serious adverse events, all-cause mortality, cardiovascular mortality, and gastrointestinal (GI) hemorrhage. The quality assessment was done by the Newcastle Ottawa Scale and Cochrane RoB 2.0 tool. A leave-one-out sensitivity analysis was performed to assess the cause of heterogeneity.
Results:
A total of three studies, involving 6,657 patients in the colchicine group and 361,240 patients in the placebo group, were included. The pooled analysis showed that colchicine resulted in a non-significant decrease in ischemic stroke recurrence (RR=0.93; 95%CI:[0.84-1.04]; p=0.22; I²=3%), overall stroke risk (RR=0.90; 95%CI:[0.74-1.09]; p=0.29; I²=45%), serious adverse events (RR=0.99; 95%CI:[0.94-1.03]; p=0.59; I²=0%) compared to the placebo. The two groups were comparable in terms of all-cause mortality (RR=1.10; 95%CI:[0.78-1.57]; p=0.58; I²=67%), cardiovascular mortality (RR=1.22; 95%CI:[0.43-3.44]; p=0.71; I²=90%), and the risk of GI hemorrhage (RR=0.76; 95%CI:[0.44-1.33]; p=0.34; I²=0%).
Conclusions:
Colchicine use showed a non-significant reduction in ischemic stroke recurrence in acute non-cardioembolic stroke patients, with a safety profile similar to that of placebo. Further research is needed to establish more definitive recommendations on its efficacy.
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