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Low-Dose Colchicine Approved for CVD Treatment


Core Concepts
Low-dose colchicine is a new approach to treating atherosclerotic cardiovascular disease by targeting inflammation.
Abstract
The recent US approval of low-dose colchicine 0.5 mg for atherosclerotic cardiovascular disease (ASCVD) signifies a novel treatment strategy focusing on inflammation. The drug's broad label allows its use in adult patients with established ASCVD or multiple cardiovascular risk factors. Key insights include: Approval of colchicine opens discussions on residual inflammatory risk in patients. The drug offers a new option for treating residual risk beyond standard care like statins. Different experts have varying opinions on the necessity of measuring hsCRP for patient selection. Colchicine is seen as a potential second pillar of ASCVD treatment alongside statins. Concerns about polypharmacy and patient selection for colchicine use are raised. Safety and tolerability of the 0.5-mg colchicine dose are considered manageable. Colchicine may become a fundamental part of cardiovascular treatment in the future.
Stats
The LoDoCo-2 trial supported colchicine's use in ASCVD with a broad population. Around 30%-40% of ASCVD patients on statins may benefit from colchicine. Colchicine is not recommended for patients with severe kidney disease.
Quotes
"This FDA approval is extremely important, as it will draw attention to the role of inflammation in atherosclerosis and the need to treat it." - Paul Ridker

Key Insights Distilled From

by Sue Hughes at www.medscape.com 06-22-2023

https://www.medscape.com/viewarticle/993578
Low-Dose Colchicine Approved for CVD: Now What?

Deeper Inquiries

How can colchicine be integrated into current treatment strategies for ASCVD?

Colchicine can be integrated into current treatment strategies for atherosclerotic cardiovascular disease (ASCVD) by targeting inflammation as a driver of atherosclerosis. It can be used in conjunction with standard treatments like statins and blood pressure control to address residual inflammatory risk in patients who are at high risk of recurrent cardiovascular events. By considering factors such as elevated LDL, diabetes, obesity, or elevated triglycerides, healthcare providers can determine which patients would benefit most from adding colchicine to their treatment regimen. The drug can serve as an additional option beyond statins to reduce residual risk in patients with ASCVD.

What are the implications of using colchicine selectively based on CRP levels?

Using colchicine selectively based on C-reactive protein (CRP) levels can help identify patients with residual inflammatory risk who are most likely to benefit from the drug. While elevated hsCRP levels indicate inflammation in ASCVD, the trials for colchicine did not require CRP measurement for patient selection. However, measuring CRP levels above 2 mg/L can be a reasonable approach to target patients with inflammation. This selective use of colchicine based on CRP levels can help optimize treatment by focusing on those individuals who are more likely to have residual plaque inflammation and benefit from anti-inflammatory therapy.

How might the role of colchicine evolve in cardiovascular treatment over time?

The role of colchicine in cardiovascular treatment is expected to evolve over time, potentially becoming a significant component of ASCVD management. As more healthcare providers become comfortable with its use and efficacy, colchicine may be prescribed more widely, starting with cardiologists and eventually being integrated into primary care practice. It could become a key part of the backbone of cardiovascular treatment, similar to statins, by targeting inflammation as a crucial factor in atherosclerosis. The drug's safety profile and effectiveness in reducing morbidity from coronary disease make it a promising addition to current treatment strategies for ASCVD.
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