Author + information
- Benjamin Van Tassell, PharmD, BCPS∗ (, )
- Justin Canada, CEP,
- Ross Arena, PhD and
- Antonio Abbate, MD, PhD
- ↵∗Pharmacy, Virginia Commonwealth University, 410 North 12th Street, Richmond, Virginia 23298
We read with interest the study of colchicine in stable heart failure by Deftereos et al. (1). Colchicine used at a dose of 0.5 mg twice daily was safe in patients with heart failure and, at least in part, effective in reducing systemic inflammation. However, the study failed to show a significant improvement in New York Heart Association functional class or functional capacity with colchicine treatment. When considering why colchicine inhibited inflammation, yet had no significant clinical advantage (2), we put forth the following considerations and questions:
First, the study employed an exercise treadmill test and measured exercise duration with a mean duration of 11 min of the modified Bruce protocol, which seemingly reflects a group of patients with mild-to-moderate exercise intolerance and certainly not severe limitations. We have recently assessed a small series of patients treated with another anti-inflammatory drug, anakinra, and found that the greatest improvement in functional capacity was seen in those patients with severe baseline impairment (3). This previous study also employed cardiopulmonary exercise testing, a highly reliable method that allows for direct measurement of oxygen consumption via expired gas analysis. We therefore question whether stratifying patients according to baseline disease severity would reveal any beneficial effect of colchicine in those with a greater functional impairment and whether using cardiopulmonary testing with gas exchange would provide a greater sensitivity.
Second, although colchicine produced a significant reduction in C-reactive protein (CRP), the on-treatment CRP levels were still markedly abnormal and thus suggest that the inhibition of the inflammatory process was incomplete. We question whether stratifying according to either on-treatment CRP or change in CRP would identify a subgroup of patients who benefitted more from colchicine.
Finally, we are grateful for this report because it highlights the safety of this colchicine regimen, which is currently being widely employed for different indications, and may serve as the basis for additional studies exploring colchicine in other cohorts of patients—including, perhaps, those with more unstable clinical syndromes (4).
- American College of Cardiology Foundation
- Deftereos S.,
- Giannopoulos G.,
- Panagopoulou V.,
- et al.
- Mann D.L.
- Nidorf S.M.,
- Eikelboom J.W.,
- Budgeon C.A.,
- Thompson P.L.