A prospective investigation into the effect of colchicine on tuberculous pericarditis.

Abstract

INTRODUCTION:

Tuberculous (TB) pericarditis carries significant mortality and morbidity rates, not only during the primary infection, but also as part of the granulomatous scar-forming fibrocalcific constrictive pericarditis so commonly associated with this disease. Numerous therapies have previously been investigated as adjuvant strategies in the prevention of pericardial constriction. Colchicine is well described in the treatment of various aetiologies of pericarditis. The aim of this research was to investigate the merit for the use of colchicine in the management of tuberculous pericarditis, specifically to prevent constrictive pericarditis.

METHODS:

This pilot study was designed as a prospective, double-blinded, randomised, control cohort study and was conducted at a secondary level hospital in the Northern Cape of South Africa between August 2013 and December 2015. Patients with a probable or definite diagnosis of TB pericarditis were included (n = 33). Study participants with pericardial effusions amenable to pericardiocentesis underwent aspiration until dryness. All patients were treated with standard TB treatment and corticosteroids in accordance with the South African Tuberculosis Treatment Guidelines. Patients were randomised to an intervention and control group using a web-based computer system that ensured assignment concealment. The intervention group received colchicine 1.0 mg per day for six weeks and the control group received a placebo for the same period. Patients were followed up with serial echocardiography for 16 weeks. The primary outcome assessed was the development of pericardial constriction. Upon completion of the research period, the blinding was unveiled and data were presented for statistical analysis.

RESULTS:

TB pericarditis was found exclusively in HIV-positive individuals. The incidence of pericardial constriction in our cohort was 23.8%. No demonstrable benefit with the use of colchicine was found in terms of prevention of pericardial constriction (p = 0.88, relative risk 1.07, 95% CI: 0.46-2.46). Interestingly, pericardiocentesis appeared to decrease the incidence of pericardial constriction.

CONCLUSION:

Based on this research, the use of colchicine in TB pericarditis cannot be advised. Adjuvant therapy in the prevention of pericardial constriction is still being investigated and routine pericardiocentesis may prove to be beneficial in this regard.

• Authors: Jurgens Jacobus Liebenberg, Catherine Jane Dold, Lourens Rasmus Olivier
• Journal: Cardiovascular journal of Africa (Cardiovasc J Afr) 2016 Nov/Dec Vol. 27 Issue 6 Pg. 350-355 ISSN: 1680-0745 [Electronic] South Africa
• PMID: 27965998 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents
• Antitubercular Agents
• Colchicine

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Anti-Inflammatory Agents (therapeutic use)
• Antitubercular Agents (therapeutic use)
• Coinfection
• Colchicine (therapeutic use)
• Double-Blind Method
• Echocardiography, Doppler, Color
• Echocardiography, Doppler, Pulsed
• Female
• HIV Infections (diagnosis, epidemiology)
• Humans
• Incidence
• Male
• Pericardial Effusion (microbiology, therapy)
• Pericardiocentesis
• Pericarditis, Constrictive (diagnostic imaging, epidemiology, microbiology, prevention & control)
• Pericarditis, Tuberculous (diagnostic imaging, drug therapy, epidemiology, microbiology)
• Pilot Projects
• Prospective Studies
• Risk Factors
• South Africa (epidemiology)
• Time Factors
• Treatment Outcome