Title: Colchicine Use and Risk of Stroke Recurrence in Acute Non-Cardiogenic Ischemic Stroke Patients
Authors: Abdullah, Hassan Waseem, Jamir Pitton Rissardo, Zain Abideen, Sania Aimen, Ana Leticia Fornari Caprara, and Vishnu Byroju
Conference: 2025 AAN Annual Meeting, San Diego, CA
Objective
To evaluate the efficacy and safety of long-term colchicine use in preventing stroke recurrence in acute non-cardiogenic ischemic stroke patients.
Background
Anti-inflammatory therapy with colchicine has been shown to prevent vascular recurrence in coronary artery disease. In contrast to coronary artery disease, which is primarily driven by atherosclerosis, non-cardioembolic acute ischemic stroke has multiple underlying causes, including atherosclerosis, small vessel disease, and unknown etiology.
Design/Methods
Databases like PubMed, Embase, and Cochrane were searched till September 2024. Risk ratios (RR) with 95% confidence intervals (CI) were pooled for the dichotomous outcomes under the random effects model on Review Manager 5.4.1. The primary outcome was ischemic stroke recurrence. Secondary outcomes were overall stroke risk (ischemic and non-ischemic), serious adverse events, all-cause mortality, cardiovascular mortality, and gastrointestinal (GI) hemorrhage. The quality assessment was done by the Newcastle Ottawa Scale and Cochrane RoB 2.0 tool. A leave-one-out sensitivity analysis was performed to assess the cause of heterogeneity.
Results
A total of three studies, involving 6,657 patients in the colchicine group and 361,240 patients in the placebo group, were included. The pooled analysis showed that colchicine resulted in a non-significant decrease in ischemic stroke recurrence (RR=0.93; 95% CI: [0.84–1.04]; p=0.22; I2=3%), overall stroke risk (RR=0.90; 95% CI: [0.74–1.09]; p=0.29; I2=45%), serious adverse events (RR=0.99; 95% CI: [0.94–1.03]; p=0.59; I2=0%) compared to the placebo. The two groups were comparable in terms of all-cause mortality (RR=1.10; 95% CI:[0.78–1.57]; p=0.58; I2=67%), cardiovascular mortality (RR=1.22; 95% CI:[0.43–3.44]; p=0.71; I2=90%), and the risk of GI hemorrhage (RR=0.76; 95% CI:[0.44–1.33]; p=0.34; I2=0%).
Conclusions
Colchicine use showed a non-significant reduction in ischemic stroke recurrence in acute non-cardioembolic stroke patients, with a safety profile similar to that of placebo. Further research is needed to establish more definitive recommendations on its efficacy.
Citation
Abdullah, Waseem H, Rissardo JP, Abideen Z, Aimen S, Caprara AL, Byroju V. Colchicine Use and Risk of Stroke Recurrence in Acute Non-Cardiogenic Ischemic Stroke Patients: A Systematic Review and Meta-analysis (P4-14.006). Neurology 2025;104(7_Supplement_1):4708. doi: 10.1212/WNL.0000000000211860
Figure. Forest plots of colchicine use and risk of stroke recurrence in acute non-cardiogenic ischemic stroke patients. Forest plots illustrating the association between colchicine use and three clinical outcomes: ischemic stroke recurrence, all-cause mortality, and serious adverse events. Effect estimates are presented as risk ratios (RR) with corresponding 95% confidence intervals (CI). Each plot summarizes data from included studies, highlighting the direction and magnitude of effect for each outcome.