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Clinician Article

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Low-Dose Colchicine in Patients With Type 2 Diabetes and Recent Myocardial Infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT).

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• Roubille F
• Bouabdallaoui N
• Kouz S
• Waters DD
• Diaz R
• Maggioni AP, et al.

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Clinical Comments

Cardiology

Amazing!! Should be read widely.

Endocrine

Although the results from the main trial were compelling, the findings from this subgroup analysis of patients with type 2 diabetes were similar to the main trial results. This is hardly surprising, as one would not expect a different effect of this medication in patients with diabetes who have had an MI.

Endocrine

Based on the two landmark trials, low-dose colchicine has recently been recommended by leading cardiovascular societies (such as ESC and ACC) as a secondary prevention of CVD, particularly among individuals with severe or uncontrolled risk factors, including diabetes. This study is a prespecified subgroup analysis of the landmark trial from 2019 using colchicine after MI to reduce MACE events. It confirmed that using low-dose colchicine in patients with T2D or prediabetes reduces multiple cardiovascular and cerebrovascular endpoints following MI, with a risk reduction of 35% during the median follow-up of 22.6 months. This sheds light on the additional treatment modalities in these populations with uncontrolled risk factors despite optimal medical therapy. Noteworthy, despite proven benefits, this therapy is not fostered enough by the pharmaceutical industry for this indication, presumably because colchicine is an old and not profitable medication.

Endocrine

The findings confirm what we learnt from the COLCOT trial and show that, in people with diabetes, the benefits of colchicine are even greater.

Family Medicine (FM)/General Practice (GP)

A subgroup analysis of the COLCOT trial in patients with T2DM showing improved CVD outcomes with long-term use of colchicine. This is of interest to both primary care physicians and cardiologists.

General Internal Medicine-Primary Care(US)

I’m not sure this adds anything to the main trial results. Why would the authors expect something less in this subgroup? The usual rule of thumb is the higher the risk, the greater the benefit of an intervention. Patients with DM are at higher risk, so these results confirm only what should have been the a priori expectation for this subgroup. I'm not enthusiastic and I’m not sure it really matters whether or not my primary care physician colleagues know the results of this study.

General Internal Medicine-Primary Care(US)

Although this is a secondary analysis, it was pre-specified and has an interesting finding worthy of discussion. Many providers are probably not aware of the potential role of colchicine in this population.

General Internal Medicine-Primary Care(US)

Nothing to lose here: inexpensive, safe, and the side effects at this dose are rather small.