ISC 2025 | Efficacy of colchicine for stroke prevention: a meta-analysis of CHANCE-3 and CONVINCE

Good morning everybody, myself Vikash Jaiswal and I’m from India. I’m presenting my study that I have presented at AHA Stroke. And this study is all about the short and long term efficacy of colchicine for prevention of stroke and major adverse cardiovascular event, a meta-analysis of CHANCE-3 and CONVINCE randomized controlled trials. I would like to thank all the co-authors involved in the study and we don’t have any conflict of interest related to this study or the video platform that we are getting an opportunity to record or any financial disclosure to disclose. So as we know inflammation can play a critical role in atherosclerotic cardiovascular disease and the role of anti-inflammatory medications in patients with CVD has been a matter of intense investigation. Colchicine is a commonly used anti-inflammatory agent that has been effectively used in the treatment of gout disease and familial Mediterranean fever. Colchicine has known to reduce a major adverse cardiovascular event and stroke among patients with coronary artery disease. However, its efficacy with short and long-term use and the risk of stroke has not been well studied till date with all the available randomized controlled trials. Hence, we sought to evaluate the short and long-term efficacy of colchicine for prevention of stroke and major adverse cardiovascular event. Now we’re going to the methodology sections. In this, we’ve taken studies until 20th July 2024, and the inclusion criteria was adult more than 18 years of age, randomized control trial studies with two arm in one with colchicine and another with placebo as in control group and having a desired outcome of a stroke and adverse cardiovascular event. An exclusion criteria was studies with less than 18 years of patients or performed an animal case report or less no desired outcomes and our primary outcome was stroke and the secondary outcome was any adverse cardiovascular event, myocardial infarction, all-cause mortality, and cardiovascular mortality. Now, the statistical analysis, we performed a conventional meta-analysis for primary and secondary outcome and adopted the DerSimonian and Laird random-effect model for the study variants. Outcomes were reported as pooled odds ratio in their corresponding 95% confidence interval. A statistical analysis was made if the 95% confidence interval does not cross numeric value 1. And the total P value of less than 0.05 was considered as statistical significant. Now we come into the results section. A total of 16 randomized controlled trials, and of which 24,067 patients were included in our analysis, of which 12,538 patients in colchicine and 12,429 in control group were included. The mean age of the patients among colchicine and placebo group was comparable. The most common comorbidity among colchicine and placebo group was diabetes mellitus with nearly 50% in both the groups and hypertension of 50% each almost. Now the results, we will be coming to it. The pooled analysis of primary outcome shows that colchicine with longer follow-up means more than 6 months, significantly reduced the risk of stroke by 39%. However, colchicine with shorter follow-up duration shows comparable risk of stroke compared with placebo. Similarly, colchicine reduced the risk of MACE by 34% among patients with long-term follow-up, but not in the short-term group of patients. However, the risk of cardiovascular mortality at long-term follow-up and short-term follow-up and the risk of all-cause mortality at long-term follow-up and short-term follow-up was comparable between colchicine and placebo group. And this is the table summarizing all studies with colchicine and placebo. Now we’re going to the next slide. And this is all the forest plot included in the video. We can see all the outcomes from stroke to MACE, at the more than six months and less than six months efficacy of colchicine among patients with CVD or stroke. Now we’re moving to the next slide, and the conclusion of the study is, these findings suggest that colchicine reduced the risk of stroke and MACE at long-term follow-up more than six months but not among patients with short follow-up duration. These key findings for the first time shows colchicine can be more effective if used for longer duration among high-risk patients. Thank you everyone.

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