Impact of colchicine on mortality and morbidity in COVID-19: a systematic review

Abstract

Introduction Colchicine, because of its anti-inflammatory and possible anti-viral properties, has been proposed as potential therapeutic option for COVID-19. The role of colchicine to mitigate “cytokine storm” and to decrease the severity and mortality associated with COVID-19 has been evaluated in many studies. Objective To evaluate the role of colchicine on morbidity and mortality in COVID-19 patients. Methods This systematic review was conducted in accordance with the PRISMA recommendations. The literature search was conducted in 6 medical databases from inception to February 17, 2021 to identify studies evaluating colchicine as a therapeutic agent in COVID-19. All included studies were evaluated for risk of bias (ROB) using the Revised Cochrane ROB tool for randomised controlled trials (RCTs) and Newcastle-Ottawa Scale (NOS) for case-control and cohort studies. Results Four RCTs and four observational studies were included in the final analysis. One study evaluated colchicine in outpatients, while all others evaluated inpatient use of colchicine. There was significant variability in treatment protocols for colchicine and standard of care in all studies. A statistically significant decrease in all-cause mortality was observed in three observational studies. The risk of mechanical ventilation was significantly reduced only in one observational study. Length of hospitalisation was significantly reduced in two RCTs. Risk for hospitalisation was not significantly decreased in the study evaluating colchicine in outpatients. Very few studies had low risk of bias. Conclusion Based on the available data, colchicine shall not be recommended to treat COVID-19. Further high-quality and multi-center RCTs are required to assess the meaningful impact of this drug in COVID-19. KEY MESSAGES Colchicine, an anti-inflammatory agent has demonstrated anti-viral properties in in-vitro studies by degrading the microtubules, as well as by inhibiting the production of pro-inflammatory cytokines. Colchicine has been studied as a potential therapeutic option for COVID-19, with variable results. Until further research can establish the efficacy of colchicine in COVID-19, the use of colchicine in COVID-19 shall be restricted to clinical trials.

FRAGILE-COLCOVID19: A Clinical Trial Based on Early Administration of an Oral Combination of Colchicine and Prednisone in Elderly Patients with COVID-19 in Geriatric Facilities

“…With regard to the data from systematic reviews and meta-analyses, including randomized clinical trials and observational studies, regarding the use of colchicine in COVID-19, controversial results have been reported, mostly due to the number and type of articles included at different times during the COVID-19 pandemic. While several meta-analyses of randomized clinical trials [ 52 – 55 ] and observational studies [ 56 , 57 ] have provided negative or inconclusive results regarding the role of colchicine in COVID-19 mortality, a higher number of these studies found positive effects of colchicine in terms of reduction of hospital admissions [ 52 ], hospitalization time [ 58 ], and mortality [ 53 , 54 , 59 – 64 ].…”

Photolysis and cytotoxicity of the potentially toxic composition of daylily flower: colchicine

“…[ 8 – 10 ]. Recent studies showed that colchicine is potential to prevent Covid-19 complications [ 11 , 12 ]. Colchicine consists of a trimethoxy benzene ring (A-ring), a seven-membered ring (B-ring) with an acetamide group, and a methoxy tropone ring (C-ring) in molecule.…”

Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial

“… 8 The results of randomised trials of colchicine and antithrombotic therapies in patients with COVID-19 have been inconclusive and additional data are required to clarify their role. 9 , 10 Aspirin and rivaroxaban are effective antithrombotic drugs when used alone or in combination in patients with cardiovascular disease, 11 , 12 but the combination has not been tested in patients with COVID-19.…”