Low-dose colchicine for stroke prevention: A systematic overview of systematic reviews and meta-analyses

Background

Stroke incidence remains a significant concern despite optimized prevention strategies. Colchicine shows potential for improving stroke prevention globally.

Aims

To summarize efficacy and safety estimates from systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) comparing colchicine to usual care or placebo for stroke prevention.

Methods

We conducted an overview of SRMAs according to the Preferred Reporting Items for Overviews of Reviews guidelines through a systematic search in Pubmed, Embase, and the Cochrane Library. Statistical analysis was performed using RevMan Web. Heterogeneity was assessed with I² statistics.

Results

Thirty-two studies were included. Colchicine significantly reduced stroke recurrence (RR 0.46; 95 % CI 0.41–0.52; p < 0.0001; I² = 0 %; OR 0.44, 95 % CI 0.36–0.55; p < 0.0001; I² = 0 %) but increased gastrointestinal adverse events (RR 1.54, 95 % CI 1.33–1.79; p < 0.0001; I² = 63 %; OR 1.60, 95 % CI 1.08–2.38; p = 0.0007; I² = 82 %). Most SRMAs (93.75 %) showed reduced stroke incidence (RR 0.26–0.54), while 65.22 % reported increased gastrointestinal events (RR 1.05–2.66). No significant differences were observed in mortality, infection or cancer rates. Overall quality was appraised as high in 28.12 %, moderate in 6.25 %, low in 40.06 %, and critically low in 25 % of SRMAs. Data were primarily derived from seven RCTs with low risk of bias.

Conclusions

Moderate-quality evidence supports colchicine's benefits and reasonable safety for preventing stroke among high-risk populations. However, stroke was not the primary endpoint in analyzed studies. RCTs directly assessing colchicine for stroke prevention are warranted.