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Fig. 6 | BMC Cardiovascular Disorders

Fig. 6

From: Colchicine in cardiac disease: a systematic review and meta-analysis of randomized controlled trials

Fig. 6

Forest Plot for Gastrointestinal Adverse Events. Individual and pooled risk ratios (RR) with 95 % confidence intervals (CI) for randomized controlled trials (RCTs) comparing colchicine to placebo or control in patients with cardiovascular diseases, pericarditis, and post pericardiotomy or radiofrequency (RF) ablation. The pooled RRs with 95 % CI were calculated using random-effects models. Weight refers to the contribution of each study to the overall pooled estimate of treatment effect. Each square and horizontal line denotes the point estimate and 95 % CI for each trial’s RR. The diamonds signify the pooled RR; the diamond’s centre denotes the point estimate and width denotes the 95 % CI. The pericarditis patient trials [1822] which reduced the dose of colchicine for intolerance or low body weight (<70 kg) and enrolled generally younger patients (mean age 48–57), showed no significant increase in gastrointestinal side effects. This was different than the results from the other trials which showed a doubling of risk (interaction p = 0.01). Including data from all 7 RCTs that reduced the dose of colchicine for intolerance or body weight <70 kg [1822, 24, 25], the increase in gastrointestinal adverse events was lower but still statistically significant (RR 1.56, 95 % CI 1.09-2.24, p = 0.01, I2 = 0 %; 7 RCTs, 1524 patients) suggesting that dose reduction by itself is not sufficient to eliminate gastrointestinal side effects. For two RCTs that reported non-diarrhea gastrointestinal side effects separately from the diarrhea side effects we assumed that the 5/130 vs. 4/67 patients with nausea or vomiting and 0/130 vs. 1/67 patients with dyspepsia were different than the 36/130 vs. 3/67 patients with diarrhea [16] and the 6/103 vs. 3/103 patients with nausea were different than the 10/103 vs. 2/103 patients with diarrhea [27]. Results are similar if one assumes that these events occurred in the same patients for these 2 RCTs (overall RR 2.11, 95 % CI 1.54-2.89, p < 0.0001, I2 = 26 %; 216/1559 [13.9 %] vs. 77/1463 [5.3 %])

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