Treatment with colchicine appears to lower the risk of stroke and major adverse cardiovascular events (MACE) when used for longer duration, according to a study presented at ISC 2025. This beneficial effect, however, is not observed among patients with shorter follow-up duration. 

“These key findings for the first time show colchicine can be more effective if used for longer duration among high-risk patients,” said lead study author Dr Vikash Jaiswal from the JCCR Cardiology Research in Jaunpur, India.  

Jaiswal and his team performed a systematic review and meta-analysis of randomized controlled trials to explore the short- and long-term efficacy of colchicine for the prevention of stroke and MACE. They searched the databases of PubMed, Embase, and Clinicaltrial.gov from inception until 20 July 2024. 

A random-effect model was used to pool the odds ratios (ORs) from eligible studies, with a p-value of <0.05 considered as statistically significant. Jaiswal and colleagues then categories the studies based on their follow-up duration: <6 months vs ≥6 months. 

Cardiac benefits 

Sixteen randomized controlled trials, which included a total of 24,967 patients (12,538 in the colchicine group and 12,429 in the placebo group), met the eligibility criteria and were included in the meta-analysis. The mean age of participants in the colchicine group was 61.69 years, while that in the placebo group was 62 years. [ISC 2025, abstract 16] 

The pooled analysis by Jaiswal and colleagues revealed a beneficial effect for colchicine with longer follow-up duration, significantly reducing the risk of stroke by 39 percent (OR, 0.61, 95 percent confidence interval [CI], 0.39?0.96). However, they found that the risk of stroke was similar between the colchicine and placebo groups in patients with shorter follow-up (OR, 0.98, 95 percent CI, 0.82?1.16). 

In addition, the use of colchicine was associated with a 34-percent reduction in the risk of MACE among patients with longer follow-up (OR, 0.66, 95 percent CI, 0.53?0.82), but not in those with short-term follow-up (OR, 0.91, 95 percent CI, 0.05?15.54). 

On the other hand, the risks of cardiovascular mortality at long-term (OR, 0.81, 95 percent CI, 0.47?1.39) and short-term follow-up (OR, 0.71, 95 percent CI, 0.40?1.27) and all-cause mortality at long-term (OR, 1.04, 95 percent CI, 0.67?1.63) and short-term follow-up (OR, 0.74, 95 percent CI, 0.50?1.12) did not differ significantly between the colchicine and placebo groups. 

“Colchicine hasbeen shown to reduce MACE and stroke among patients with coronary artery disease,” Jaiswal said. “However, its efficacy with short and long use and risk of stroke has not been well studied with conflicting results to date.” 

Mechanism 

An oral therapeutic agent, colchicine binds tubulin and prevents tubulin polymerization, thereby disrupting the cellular cytoskeleton, mitosis, and intracellular transport activities. [Circulation2022;145:61-78] 

Preferentially, colchicine gathers in neutrophils due to the lack of the P-glycoprotein membrane efflux pump, which then substantially influences neutrophil activity. [Blood1994;83:2451-2458] 

“Specifically, colchicine has been shown to inhibit the directed migration of neutrophils to an inflamed focus (chemotaxis) and decrease adhesion of neutrophils to inflamed endothelium by diminished quantitative surface expression of L-selectin adhesion molecules,” according to researchers. [Arthritis Rheum1965;8:757-764; J Clin Invest1995;96:994-1002]