A review of the rational and current evidence on colchicine for COVID-19

Abstract

: The current coronavirus disease (COVID-19) pandemic has affected about 247 million individuals around the world. Despite the extensive research efforts, there are currently few therapeutic options that offer direct clinical benefits for COVID-19 patients. Despite the advances in our understanding of COVID-19, the mortality rates remain significantly high owing to the high viral transmission in several countries and the rise of various mutations in the SARS-CoV-2. One of the currently available and widely used drugs that combine both anti-inflammatory and immunomodulatory actions is colchicine, which has been proposed as a possible treatment option for COVID-19. Colchicine still did not get much attention from the medical and scientific communities despite its anti-inflammatory and immunomodulatory mechanisms of action and its positive preliminary data from early trials. This literature review article provides the scientific rationale for repurposing colchicine as a potential therapeutic of COVID-19. Further, we summarize its mechanisms of action and possible roles in COVID-19 patients. Finally, we supplement this review with a summary of the doses, side effects, and the early efficacy data from clinical trials to date. Despite the early promising findings from multiple observational and clinical trials about the potential of Colchicine in COVID-19, data from the RECOVERY trial, the largest COVID-19 RCT in the world, showed no evidence of clinical benefits in mortality, hospital stays, or disease progression (n=11340 patients). However, multiple other smaller clinical trials showed significant clinical benefits. We conclude that while current evidence does not support the use of colchicine for treating COVID-19, the present body of evidence is heterogeneous and inconclusive. The drug cannot be used in clinical practice or abandoned from clinical research without additional large RCTs providing more robust evidence. At the present, the drug should not be used except for investigational purposes.