Colchicine reduces the risk of major cardiovascular events in patients with chronic coronary disease, according to results from the LoDoCo2 trial. Mark Nidorf, MD, MBBS, of GenesisCare, Australia, presented the results during Hot Line session Monday at the European Society of Cardiology 2020 virtual congress. Colchicine has historically been used to treat inflammation and now is commonly used to treat gout. The medication also inhibits several inflammatory pathways known to be important in atherosclerosis. The LoDoCo (Low Dose Colchicine) pilot trial suggested that 0.5 mg of colchicine daily was safe and effective for preventing cardiovascular events in patients with coronary artery disease. LoDoCo2 was an investigator-initiated, double-blind, placebo-controlled, event-driven trial that randomized 5,552 patients who had chronic coronary disease (stable symptoms for more than 6 months) and were tolerant to colchicine during a 30-day open-label run-in phase to take either colchicine 0.5 mg daily or a placebo. The primary endpoint was a composite of cardiovascular death, myocardial infarction, ischemic stroke, or ischemic-driven coronary revascularization. Enrollment began in Australia in August 2014 and was expanded to the Netherlands in 2016, with completion of enrollment in 2018. The study’s median follow-up was close to 30 months. The primary endpoint occurred in 187 (6.8%) patients in the colchicine group and 264 (9.6%) patients in the placebo group (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.57-0.83; p<0.001). When the components of the primary endpoint were analyzed separately, a consistent trend was seen with all endpoints, and myocardial infarction and ischemia-driven coronary revascularization were both significantly less frequent in the colchicine group. One concern about colchicine is the medication’s side-effect profile; however, In this study more than 90% of patients were tolerant to open-label colchicine. Of those who were intolerant, most reported transient gastrointestinal symptoms. In patients randomized into the trial, low-dose colchicine was well-tolerated over the longer term: the rate of permanent discontinuation was low (<10%) and similar to those taking placebo. Nidorf noted that the magnitude of colchicine’s effect on cardiovascular outcomes was consistent with that found in the CANTOS and COLCOT trials. “The results of the LoDoCo2 trial establish colchicine as a potential new option for long-term prevention of cardiovascular events in patients with chronic coronary disease,” he said. Aspen Pharmacare Australia provided the colchicine and matching placebo tablets for the trial in Australia at no cost. A pharmaceutical consortium consisting of Teva, Haarlem, Disphar, Baarn and Tiofarma, Oud-Beijerland, all in the Netherlands, provided colchicine and matching placebo tablets at no cost, as well as an unrestricted research grant.