Exploring the Role of Colchicine (Lodoco) in Chronic Coronary Disease Management
Recent interest in colchicine (Lodoco) emerges from its potential to reduce cardiovascular (CV) risk due to its anti-inflammatory properties. Originally formulated for gout, Lodoco is now approved at 0.5 mg, distinct from the standard 0.6 mg dosage.
Evidence indicates that adding colchicine 0.5 mg/day to standard care (antiplatelets, statins) prevents one CV event per 36 patients treated over approximately two years. Initiating colchicine shortly after a myocardial infarction may further mitigate CV events. However, it’s crucial to note that colchicine does not decrease mortality, with benefits primarily seen in reducing angina, heart attack, and stroke.
Be cautious when prescribing to patients with an eGFR < 60 mL/min/1.73 m², as data is limited. Additionally, colchicine has a narrow therapeutic index, posing risks of toxicity, such as bone marrow suppression and rhabdomyolysis, especially in those with hepatic or renal impairment or on strong CYP3A4 inhibitors.
Exercise prudence when prescribing Lodoco, given its high cost and potential lack of insurance coverage. Avoid the 0.6 mg dose, as insufficient evidence supports its efficacy in reducing CV risk.
Patient management:
- Optimize standard CV therapy adherence, including antiplatelet agents and lipid-lowering medications.
- Reserve colchicine 0.5 mg/day for select patients with recurrent CV events despite optimal management and no significant drug interactions.
- Educate patients on potential gastrointestinal upset and emphasize the importance of reporting muscle pain, weakness, severe diarrhea, or signs of infection promptly.
Stay updated on emerging therapies like colchicine for chronic coronary disease, ensuring evidence-based management for improved patient outcomes.
Take-home pointsDiscover colchicine's potential to reduce cardiovascular risk in patients...
- Assess chronic coronary disease patients for appropriate colchicine therapy.
- Prescribe colchicine 0.5 mg/day as an adjunct to standard care.
- Evaluate effectiveness by preventing one CV event per 36 patients treated.
- Monitor renal function, ensuring eGFR is above 60 mL/min/1.73 m².
- Educate patients on potential side effects, including gastrointestinal upset.
- Report gastrointestinal side effects, including diarrhea and nausea, promptly and instruct patients to report muscle pain or weakness immediately.
References
- Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines [published correction appears in Circulation. 2023 Sep 26;148(13):e148. doi: 10.1161/CIR.0000000000001183] [published correction appears in Circulation. 2023 Dec 5;148(23):e186. doi: 10.1161/CIR.0000000000001195]. Circulation. 2023;148(9):e9-e119. doi:10.1161/CIR.0000000000001168
- Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020;383(19):1838-1847. doi:10.1056/NEJMoa2021372
- Tardif JC, Kouz S, Waters DD, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019;381(26):2497-2505. doi:10.1056/NEJMoa1912388
- Nelson K, Fuster V, Ridker PM. Low-Dose Colchicine for Secondary Prevention of Coronary Artery Disease: JACC Review Topic of the Week. J Am Coll Cardiol. 2023;82(7):648-660. doi:10.1016/j.jacc.2023.05.055
- Hansten PD, Tan MS, Horn JR, et al. Colchicine Drug Interaction Errors and Misunderstandings: Recommendations for Improved Evidence-Based Management. Drug Saf. 2023;46(3):223-242. doi:10.1007/s40264-022-01265-1
Keywords: Colchicine, Lodoco, Chronic coronary disease, Cardiovascular risk reduction, Anti-inflammatory therapy, eGFR, Myopathy risk, Statin therapy, CV events prevention
Join the conversation