October 17, 2013
News Review From Harvard Medical School -- Drug May Improve Treatment of Pericarditis
A drug long used for gout may also be an effective first treatment for pericarditis, a study finds. The drug, colchicine, also may help to prevent the condition from coming back. Pericarditis is an inflammation of the lining around the heart. Colchicine (Colcrys) reduces inflammation. However, it usually is not used as a first treatment for pericarditis. The study included 240 people with pericarditis. Everyone received standard treatment with aspirin or ibuprofen for 3 months. People were randomly divided into 2 groups. One group also received colchicine. The other group received look-alike placebo (fake) pills. After treatment, 83% of those who took colchicine improved and didn't have a return of symptoms. Only 63% of the placebo group had this positive result. The colchicine group also had quicker relief of symptoms. And they were less likely to end up in the hospital. The New England Journal of Medicine published the study October 17. MedPage Today wrote about it.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Have you ever heard of pericarditis?
It's a common condition in which the thin membrane on the outer surface of the heart becomes inflamed.
Pericarditis has several causes. They include:
- Viral infections
- Injury to the heart, such as a heart attack
However, there is often no cause found.
People with pericarditis can suffer with chest pain, fever and difficulty breathing. Sometimes the inflammation of pericarditis causes fluid to build up around the heart and reduces its pumping ability. This problem is called pericardial tamponade. It can be life threatening.
A new study analyzed the impact of an old treatment, colchicine, for pericarditis. Colchicine has been used since ancient times for several conditions, especially for gout. It's commonly prescribed for pericarditis as well.
The study appears in the latest edition of the New England Journal of Medicine. Researchers randomly assigned 240 people with a first episode of pericarditis to receive a low dose of colchicine or a placebo for 3 months. Everyone also received standard anti-inflammatory medicines, such as aspirin or ibuprofen. About one-quarter of the cases were caused by a heart injury. Most had an unknown cause.
As compared with the placebo group, those receiving colchicine were:
- More likely to have sustained improvement (83% with colchicine vs. 63% with placebo)
- More likely to be symptom-free within 3 days (81% with colchicine vs. 60% with placebo)
- Less likely to have repeated episodes or a hospital admission
- No more likely to report a side effect
These findings suggest that colchicine treatment may be helpful for newly diagnosed pericarditis and also reduce the chances that it will return. This is useful to know because now pericarditis is often treated with colchicine only after other medicines have not worked or if the condition returns.
What Changes Can I Make Now?
The first change you can make is to expand your thinking about heart disease beyond heart attacks. In fact, there are several other types of heart disease. They include:
- Pericardial disease -- These disorders affect the lining of the heart. Pericarditis, the subject of this latest research, is the most common pericardial disorder.
- Valve disease -- A series of valves separate the four chambers of the heart. They ensure that blood flows in the proper direction and in time with the pumping motion of the heart. Scarring, tearing or infection of a valve can make it leaky or too narrow. These problems can prevent efficient flow of blood through the heart and into the rest of the body.
- Rhythm problems (arrhythmias) -- The heart can beat too fast, too slow or not in a regular pattern. Each of these can cause symptoms, such as lightheadedness or palpitations. Or there may be no symptoms. While many arrhythmias are harmless, they can be life threatening.
- Congestive heart failure -- Fluid backs up behind the heart into the lungs, legs or both. This occurs because the pumping force of the heart is reduced or the heart cannot relax properly between beats.
These conditions can overlap. For example, pericarditis and congestive heart failure may both occur along with or after a heart attack.
Another change you can make is how you think about old drugs. Many people think that newer drugs are better than older ones. In fact, many older drugs have not been studied carefully or compared directly with new drugs.
That's why the U.S. Food and Drug Administration has recently begun to encourage drug companies to do studies on older drugs, such as colchicine. If these studies prove the drug to be effective, the drug company is then allowed to sell the drug exclusively for several years. Typically, the price will be relatively high. In fact, the price of colchicine skyrocketed several years ago from pennies per pill to $2 or more per pill after a drug company studied it for the treatment of gout.
As this latest research shows, colchicine is probably even more effective than we had realized for pericarditis. But it's a shame that many who might benefit from taking it may not be able to afford it.
What Can I Expect Looking to the Future?
This new research included few patients with pericarditis caused by rheumatic disease, such as lupus. It had no patients with viral infection. Future studies should determine whether people with these causes of pericarditis respond as well as the people in this study.
The results of this new research suggest that in the future doctors should prescribe colchicine for people with a first bout of pericarditis due to cardiac injury or an unknown cause. As a result, people may get better faster and have fewer second attacks than in the past. The price of colchicine should come down when generic versions are once again allowed on the market.