ABSTRACT NUMBER: ESOC2026LT17 LT17 - THE EFFICACY OF COLCHICINE FOR SECONDARY PREVENTION AFTER STROKE ACCORDING TO THE PRESENCE OF ATHEROSCLEROSIS: A SECONDARY ANALYSIS OF THE CONVINCE TRIAL.

Abstract Background and aims It is uncertain whether benefit from anti-inflammatory therapies after stroke is confined to patients with atherosclerosis. Methods We performed a post-hoc analysis of the CONVINCE trial (comparing colchicine+usual care vs. usual care) in patients stratified according to the presence/absence of atherosclerosis (cervico-cranial artery plaque, coronary disease, peripheral arterial disease, or carotid revascularisation). The primary outcome was MACE (composite of fatal/non-fatal recurrent ischemic stroke or coronary event). Results The trial included 3,144 participants (1,875 with atherosclerosis, median follow-up 33.6 months, 338 MACE events). On intention-to-treat analysis, there were numerically fewer MACE events in the atherosclerosis group assigned to colchicine (105 [11.1%], 3.88 [95% CI 3.21-4.70] per 100 person-years) vs.usual care (132 [14.2%], 4.83 [4.07-5.73]/100 person-years), which was not statistically significant (HR 0.83, 0.64-1.07). There was no difference in the rate of the primary outcome according to treatment allocation in the non-atherosclerosis subgroup (HR 0.94, 0.64-1.39) (Pinteraction 0.60). There was a non-significant reduced risk of recurrent ischemic stroke in the colchicine arm (HR 0.76, 0.56-1.05) in the atherosclerosis group only. In the pre-specified on-treatment analysis, colchicine reduced the risk of MACE in patients with atherosclerosis (HR 0.76, 0.58-0.99), but not without (HR 0.95, 0.63-1.42). Conclusions There was no significant between-group interactions for colchicine and atherosclerosis for MACE. However, outcome events were numerically fewer in patients with atherosclerosis assigned to colchicine and significant benefit was observed in the on-treatment analysis in this group. Data suggest the presence of atherosclerosis should be an inclusion criteria in future trials of anti-inflammatory therapies. Conflict of interest Figure 1 - belongs to Conclusions