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Long-term colchicine for the prevention of vascular recurrent events in non-cardioembolic stroke (CONVINCE): a randomised controlled trial
P. Kelly, R. Lemmens, C. Weimar, C. Walsh, F. Purroy, M. Barber, R. Collins, S. Cronin, A. Czlonkowska, P. Desfontaines, A. De Pauw, NR. Evans, U. Fischer, C. Fonseca, J. Forbes, MD. Hill, D. Jatuzis, J. Kõrv, P. Kraft, C. Kruuse, C. Lynch, D....
Language English Country England, Great Britain
Document type Journal Article, Randomized Controlled Trial
NLK
ProQuest Central
from 1992-01-04 to 3 months ago
Nursing & Allied Health Database (ProQuest)
from 1992-01-04 to 3 months ago
Health & Medicine (ProQuest)
from 1992-01-04 to 3 months ago
Family Health Database (ProQuest)
from 1992-01-04 to 3 months ago
Psychology Database (ProQuest)
from 1992-01-04 to 3 months ago
Health Management Database (ProQuest)
from 1992-01-04 to 3 months ago
Public Health Database (ProQuest)
from 1992-01-04 to 3 months ago
- MeSH
- Stroke prevention & control MeSH
- Hospitalization statistics & numerical data MeSH
- Myocardial Infarction prevention & control MeSH
- Ischemic Stroke * prevention & control MeSH
- Colchicine * administration & dosage therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Recurrence MeSH
- Secondary Prevention * methods MeSH
- Aged MeSH
- Ischemic Attack, Transient prevention & control drug therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
BACKGROUND: Anti-inflammatory therapy with long-term colchicine prevented vascular recurrence in coronary disease. Unlike coronary disease, which is typically caused by atherosclerosis, ischaemic stroke is caused by diverse mechanisms including atherosclerosis and small vessel disease or is frequently due to an unknown cause. We aimed to investigate the hypothesis that long-term colchicine would reduce recurrent events after ischaemic stroke. METHODS: We did a randomised, parallel-group, open-label, blinded endpoint assessed trial comparing long-term colchicine (0·5 mg orally per day) plus guideline-based usual care with usual care only. Hospital-based patients with non-severe, non-cardioembolic ischaemic stroke or high-risk transient ischaemic attack were eligible. The primary endpoint was a composite of first fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation (defined as an admission to an inpatient unit or a visit to an emergency department that resulted in at least a 24 h stay [or a change in calendar date if the hospital admission or discharge times were not available]) for unstable angina. The p value for significance was 0·048 to adjust for two prespecified interim analyses conducted by the data monitoring committee, for which the steering committee and trial investigators remained blinded. The trial was registered at ClinicalTrials.gov (NCT02898610) and is completed. FINDINGS: 3154 patients were randomly assigned between Dec 19, 2016, and Nov 21, 2022, with the last follow-up on Jan 31, 2024. The trial finished before the anticipated number of outcomes was accrued (367 outcomes planned) due to budget constraints attributable to the COVID-19 pandemic. Ten patients withdrew consent for analysis of their data, leaving 3144 patients in the intention-to-treat analysis: 1569 (colchicine and usual care) and 1575 (usual care alone). A primary endpoint occurred in 338 patients, 153 (9·8%) of 1569 patients allocated to colchicine and usual care and 185 (11·7%) of 1575 patients allocated to usual care alone (incidence rates 3·32 vs 3·92 per 100 person-years, hazard ratio 0·84; 95% CI 0·68-1·05, p=0·12). Although no between-group difference in C-reactive protein (CRP) was observed at baseline, patients treated with colchicine had lower CRP at 28 days and at 1, 2, and 3 years (p<0·05 for all timepoints). The rates of serious adverse events were similar in both groups. INTERPRETATION: Although no statistically significant benefit was observed on the primary intention-to-treat analysis, the findings provide new evidence supporting the rationale for anti-inflammatory therapy in further randomised trials. FUNDING: Health Research Board Ireland, Deutsche Forschungsgemeinschaft (German Research Foundation), and Fonds Wetenschappelijk Onderzoek Vlaanderen (Research Foundation Flanders), Belgium.
Biomedical Research Institute of Lleida Universitat de Lleida Lleida Spain
Center for Clinical Trials Essen University Hospital Essen Essen Germany
Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
Cork University Hospital Cork Ireland
Department of Clinical Neurosciences University of Cambridge Cambridge UK
Department of Neurology Amsterdam University Medical Centers Amsterdam Netherlands
Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
Department of Neurology University Hospital Bern and University of Bern Bern Switzerland
Department of Neurology University Hospitals Leuven Leuven Belgium
Health Research Board Stroke Clinical Trials Network Ireland Dublin Ireland
HRB Clinical Research Facility University of Galway Galway Ireland
Institute of Psychiatry and Neurology Warsaw Poland
Klinikum Main Spessart Lohr Germany
Mater Misericordiae University Hospital Dublin Ireland
Population Health Sciences Institute Newcastle University Newcastle UK
RCSI University of Medicine and Health Sciences and Beaumont Hospital Dublin Ireland
School of Medicine University College Cork Cork Ireland
School of Medicine University College Dublin Dublin Ireland
School of Medicine University of Limerick Limerick Ireland
Stroke Unit Department of Neurology CHC Groupe Santé Liège Belgium
Stroke Unit Department of Neurology Hospitalt Universitari Arnau de Vilanova de Lleida Lleida Spain
References provided by Crossref.org
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