Colchicine the third cornerstone of preventive therapy for coronary disease: LoDoCo2

Dr Mark Nidorf

Low dose colchicine significantly reduces the risk of cardiovascular events in patients with chronic coronary disease, Australian researchers say.

The findings of the LoDoCo2 study, presented at the European Society of Cardiology Congress (ESC 2020 virtual meeting) and published in the NEJM, support the repurposing of colchicine for routine secondary prevention in this patient group, according to investigators.

The Australian-Dutch study randomised over 5,500 clinically stable patients with evidence of coronary artery disease from angiography or coronary calcium scores to either 0.5 mg colchicine per day or placebo. 

Most participants had a history of a prior revascularisation (83%) subsequent to an ACS (84%) and were well treated on multiple medications including statins (94%) and other lipid lowering agents, renin-angiotensin inhibitors (72%) and anti-platelet agents (67%).

Dr Mark Nidorf, a cardiologist from GenesisCare in Perth, told the virtual Congress that colchicine was associated with a significant reduction in the primary endpoint – a composite of CV death, MI, ischaemic stroke or ischemia-driven coronary revascularisation (HR 0.69).

“The benefits were seen early and continued to accrue throughout follow-up so that by close-out 77 fewer primary events had occurred in patients taking colchicine,” he said.

The effect of colchicine also extended to the first five of eight ranked secondary end points. 

They were composites of CV, MI or ischaemic stroke (HR 0.72), MI or ischemia-driven coronary revascularisation (HR 0.67), CV death or MI (HR 0.71), and individually, ischaemia-driven coronary revascularisation (HR 0.75) and MI (HR 0.70).

“Importantly the effect of colchicine was also broadly consistent across a number of prespecified subgroups including men and women, those who are older and younger than 65, and those with and without a history of hypertension, diabetes, previous revascularisation and so forth.”

He said the traditional gout drug was also well tolerated and appeared safe. The incidence of permanent discontinuation of colchicine was low and similar to that of the control group.

Dr Nidorf told the limbic colchicine could become the third cornerstone preventive therapy for patients with coronary disease.

“The aspirin is taking care of the thrombosis; the cholesterol-lowering agents are reducing the uptake of cholesterol; but we’ve never targeted the inflammation successfully,” he said.  

“So I think that we will find this drug will be accepted because it is available and it will help prevent the need for revascularisation and hospitalisation with heart attack and that is a big advantage for people.”

“I personally feel more comfortable now with the safety and the efficacy.”

“We were initially worried about the potential for interactions with statins, but that worry has gone away now. And also colchicine doesn’t aggravate bleeding which is a big problem in our patients who take aspirin and dual antiplatelet therapies.”

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