SPC365

Efficacy and safety of non-steroidal anti-inflammatory drugs and colchicine in myopericarditis

Session: Posters - L. Cardiovascular Pharmacology
Speaker: Pedro Teixeira Carvalho

Congress: CPC 2021
Topic: L. Cardiovascular Pharmacology
Theme: 31. Pharmacology and Pharmacotherapy
Subtheme: 31.1 Cardiovascular Pharmacotherapy
Session Type: Posters
FP Number: ---
Authors: Pedro Teixeira Carvalho; Adriana Pacheco; Diana Carvalho; Lisa Ferraz; Mariana Leal; Mesquita Bastos; Raquel Ferreira; Luis Santos; Anabela Gonzaga; Ana Briosa Neves

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:#000000"><span style="font-size:medium">Background</span></span></strong></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="font-size:medium">Non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are the cornerstone of treatment for pericarditis. However, their use in myopericarditis is less consensual, since in animal models of myocarditis, NSAIDs have shown to be non-efficacious and may enhance inflammation, increasing mortality. This lead to a recommendation to use the lowest efficacious doses to control chest pain. Colchine has shown benefit in reducing pericarditis recurrence, but there is less evidence of benefit in the setting of myopericarditis.</span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="font-size:medium">The purpose of this study was to evaluate the safety and efficacy of NSAIDs and colchicine in patients hospitalized for myopericarditis.</span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:#000000"><span style="font-size:medium">Methods</span></span></strong></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="font-size:medium">This was a retrospective observational study including consecutive patients hospitalized due to myopericarditis. Hospital records were consulted to evaluate baseline characteristics, biomarkers of inflammation and myocardial injury, echocardiography and in-hospital complications. The cumulative dose of NSAIDS and colchicine during hospitalization and after discharge was assessed. Follow-up was observed, to evaluate for the occurrence of major adverse events &ndash; death, heart failure hospitalization, myopericarditis recurrence and complex ventricular arrhythmias. </span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:#000000"><span style="font-size:medium">Results:</span></span></strong></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="font-size:medium">Of the 67 patients included in the study, 78% were male and median age was 40 years (IQ 32-52). The median highest C reactive protein was 5.3 mg/dL (IQ 5.3-9.5) and the highest troponin I was 9610 pg/mL (IQ 3500-182400). 3% of patients developed heart failure during hospitalization. Median left ventricular ejection fraction at discharge was 58% (IQ 58-62). NSAIDs were given to 97% of patients during hospitalization and 90% at discharge. Colchicine was given to 25% during hospitalization and 21% at discharge. </span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="font-size:medium">Median follow-up was 3.38 years (IQ 1.97-4.50). Major adverse events occurred in 7.5% of patients &ndash; death in 3%, heart failure hospitalization in 1.5%, myopericarditis in 6.1% and complex ventricular arrhythmias in 1.5%. </span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="font-size:medium">Cumulative NSAID dose received during follow-up was significantly associated with reduced incidence of the composed endpoint of major adverse events (p=.002). Cumulative colchicine dose was associated with reduced incidence of myopericarditis recurrence. On statistical analysis, no significant sign of harm was found of colchicine or NSAID use in each of the individual pre-specified endpoints.</span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="color:#000000"><span style="font-size:medium">Conclusion</span></span></strong></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><span style="font-size:medium">NSAID and colchicine use during hospitalization and after discharge were significantly associated with reduced incidence of the composite endpoint and recurrent myopericarditis, respectively. No sign of harm was found. NSAIDs and colchicine appear to be safe in the setting of myopericarditis. Further prospective data will assess this hypothesis.</span></span></span></p>