The efficacy of colchicine in the management of coronavirus disease 2019

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infection is a recently emerged viral infection causing predominantly mild upper respiratory symptoms. However, in some instances, it might result in acute respiratory distress syndrome (ARDS) that poses a significant mortality risk. ARDS is postulated to be mediated by a surge of pro-inflammatory cytokines and chemokines, leading to a dysregulated hyper inflammatory response. Colchicine being an anti-inflammatory agent, might mitigate this dysregulated response. Thus, in the absence of therapeutic options available to manage coronavirus disease 2019 (COVID-19), it is imperative to ascertain the effect of colchicine on improving outcomes in COVID-19 patients. Method: We will perform a systematic review including a search of the following databases: PubMed, EMBASE, MEDLINE, Clinicaltrials.gov, Cochrane library, and google scholar since inception. We will include randomized controlled trials exploring the effect of colchicine on the efficacy and safety outcomes of COVID-19 patients. Subsequently, we will perform a meta-analysis utilizing the random-effects to ascertain the effect of colchicine on reducing COVID-19 related mortality (primary endpoint) and other efficacy and safety outcomes. Results: Our review results are anticipated in early 2021 (based on the completion of several ongoing randomized controlled trial). Our review results will be published in a peer-reviewed journal. Conclusion: This systematic review and meta-analysis, is exploring the effect of colchicine on the efficacy and safety outcomes of COVID-19 patients. If colchicine proved to be effective, it would be a significant milestone in the management of COVID-19, a disease with limited available therapeutic options. PROSPERO registration number: CRD42020191086

Current systematic reviews and meta-analyses of COVID-19

“…Next, physical and lab assessments that have been found to indicate a greater likelihood of more severe disease are patients presenting with dyspnea, elevated inflammatory markers (CRP, ESR, somatostatin analogue, IL-6, IL-8, PCT, D-dimers, ferritin, interferon-α, tumor necrosis factor-α), evidence of coagulopathies (elevated D-dimers, thrombocytopenia, DIC, thromboembolic events), signs of cardiac damage (elevated LDH, IL-6, creatine kinase MB, elevated Pro-B-type natriuretic peptide, right ventricular dilation/evidence of right heart strain, emerging arrhythmias), acute kidney injury, and white blood cell findings consistent with either lymphopenia or neutrophilia (the high neutrophil-to-lymphocyte ratio is positively associated with disease severity)[ 72 , 73 ].…”

Arterial stiffness and COVID‐19: A bidirectional cause‐effect relationship

“…Furthermore, the role of anti-inflammatory drugs such as colchicine, nitric oxide, and heparin in COVID-19 patients will be explored by some ongoing studies. 28…”

Role of Multifunctional Cytoskeletal Filaments in Coronaviridae Infections: Therapeutic Opportunities for COVID-19 in a Nutshell

“…Such effects are of great importance in chemotherapy medication, as they would be to a MT-based treatment for virus infection/transmission. The effect of colchicine, which inhibits microtubule polymerization, on the efficacy and safety outcomes of COVID-19 patients has been explored [ 32 ]. If its effectivity is proved, it would be a significant milestone in the management of COVID-19, a disease with limited available therapeutic options.…”