Weekly Journal Scan: colchicine after an acute ischaemic stroke shows no <i>CHANCE</i> of preventing recurrent events

Key Points• The Colchicine in High-risk Patients with Acute Minor-to-moderate Ischemic Stroke or Transient Ischemic Attack (CHANCE-3) was an investigator-initiated, randomized, double blind, placebo-controlled trial conducted at 244 centres in China.The trial enrolled patients with acute non-cardioembolic minor-to-moderate ischaemic stroke or high-risk transient ischaemic attack (TIA) who had a high-sensitivity C-reactive protein level ≥ 2 mg/L.The aim was to evaluate the efficacy and safety of low-dose colchicine vs. placebo, started within 24 h of symptom onset, in reducing subsequent stroke within 90 days. 1 • Between August 2022 and April 2023, 8343 patients were enrolled (median age 66 years; 38% women; 89% with ischaemic stroke, and 11% with TIA; median level of high-sensitivity C-reactive protein, 4.8 mg/L).Patients were enrolled if they had a National Institutes of Health Stroke Scale score of ≤5: median 2, interquartile range 1-4 (range 0-42, with higher scores indicating more severe stroke).Patients with qualifying high-risk TIA were enrolled if they had an ABCD 2 stroke risk score ≥ 4: median 5, interquartile range 4-5 (range 0-7, with higher scores indicating higher risk of stroke). 2 • Patients were randomly assigned 1:1 to receive colchicine (0.5 mg twice daily on Days 1-3, followed by 0.5 mg daily) or placebo for 90 days on a background of standard medical therapy, including antiplatelet drugs (95%), statins (96%), hypoglycaemic (76%), and anti-hypertensive drugs (73%).The primary efficacy outcome was any new stroke (ischaemic or haemorrhagic) within 90 days after randomization.The primary safety outcome was any serious adverse event during the treatment period.All efficacy and safety analyses were by intention to treat.• The primary outcome of any new stroke at 90 days occurred in 264 patients (6.3%; 8 haemorrhagic strokes) in the colchicine group and in 270 patients (6.5%; 7 haemorrhagic strokes) in the placebo group (hazard ratio, 0.98; 95% confidence interval, 0.83-1.16;P = .79).All secondary outcomes were also neutral, with no differences between the two treatment groups.These results were consistent across multiple subgroups, except that there was an apparent trend for colchicine reducing risk at ages < 65 years and increasing risk in older patients.• No excess in adverse events was observed in patients treated with colchicine.Serious adverse events occurred in 91 (2.2%) patients in the colchicine group and 88 (2.1%) in the placebo group (P = .83).Fifteen patients (0.4%) in the colchicine group and 18 patients (0.4%) in the placebo group died from non-cardiovascular causes.Similar rates of study drug discontinuation owing to serious adverse events were observed in the two groups (1.6% vs. 1.5%).Abnormal hepatic function (0.3% vs. 0.1%; P = .03)and diarrhoea (1.7% vs. 0.7%; P < .001)were more frequent in the colchicine group than in the placebo group.