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Colchicine + aspirin reduces recurrence rates and improves symptom resolution more effectively than colchicine alone or colchicine + ibuprofen in acute pericarditis.
New research shows that adding nonsteroidal anti-inflammatory drugs (NSAIDs)—most notably aspirin—to colchicine therapy improves symptom management and decreases disease recurrence in patients with acute pericarditis compared with colchicine monotherapy.
Acute pericarditis, an inflammatory disorder of the pericardium, commonly presents with sharp chest pain, a pericardial friction rub, and characteristic electrocardiographic changes. Standard management focuses on anti-inflammatory therapy to mitigate symptoms and prevent disease recurrence. While colchicine is widely advocated due to its proven role in reducing relapses, uncertainty has persisted regarding the most effective NSAID partner to use alongside it.
To address this gap, researchers executed a comprehensive meta-analysis comparing colchicine monotherapy with combination regimens of colchicine + aspirin or colchicine + ibuprofen in adults with acute pericarditis. Investigators systematically explored PubMed, EMBASE, and the Cochrane Library to explore relevant studies. Reference lists of eligible articles were also reviewed to identify additional studies. Primary outcomes included symptom resolution, recurrence of pericarditis, and treatment-related adverse events.
The pooled analysis illustrated superior efficacy of combination therapy over colchicine monotherapy, with the colchicine–aspirin regimen showing the most consistent benefit. Patients receiving colchicine in combination with aspirin experienced the lowest recurrence rates and highest rates of symptom relief, followed by those treated with colchicine + ibuprofen. Colchicine monotherapy was linked with comparatively higher recurrence and slower symptom resolution (Table 1).
Importantly, the addition of NSAIDs did not lead to a meaningful increase in adverse events, supporting the safety of combination therapy. This study reinforces colchicine as a cornerstone therapy for acute pericarditis while demonstrating that adjunctive NSAID therapy improves both recurrence prevention and symptom control. Among the combinations investigated, colchicine + aspirin yields the most favorable balance of effectiveness and safety.
Circulation
Abstract 4372145: Meta-Analysis on Acute Pericarditis Treatment: Colchicine Alone vs. Colchicine + NSAIDs (Aspirin or Ibuprofen)
Chanpreet Singh et al.
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