Can Colchicine be used to treat COVID-19 (coronavirus)?
As of the 8 July 2021 the NIH COVID-19 Treatment Guidelines Panel:
- Recommends against use of colchicine for hospitalized patients with COVID-19
- Can not recommend for or against use of colchicine in non hospitalized patients with COVID-19 due to insufficient evidence.
Colchicine has been used in clinical trials for patients with COVID-19.
The trials have been to find out whether short-term treatment with colchicine will reduce lung complications, length of hospital stays and the rate of death in COVID-19 patients.
What is Colchicine?
Colchicine is an inexpensive anti-inflammatory medication that has been in use in the United States since 1969.
It is used to decrease inflammation in gout and used for familial Mediterranean fever to reduce signs and symptoms during bout or attacks.
How is Colchicine thought to work in treating COVID-19?
COVID-19
- If you become infected with coronavirus, your immune system sends useful immune chemicals to the affected areas of the lungs to help fight the infection, which is good because this is how you recover from an infection.
- However in some people there is an overreaction by the immune system called a “cytokine storm” causing too many immune messengers to be made.
- This means major parts of the body become very inflamed and they can not work properly.
- The lungs become congested which causes severe breathing problems and pneumonia.
- The heart, liver and kidneys can also become very inflamed which can lead to serious complications, even organ failure and death.
- Colchicine was trialled for its anti-inflammatory effects when treating COVID-19. By reducing the excessive inflammation, it was hoped that the body’s immune system will be able to fight coronavirus, and reduce the complications of pneumonia, organ failure and death
COLCORONA Trial results
In the clinical study called COLCORONA colchicine was trialled to see whether it would reduce the excessive inflammatory reaction caused by coronavirus that may lead to acute respiratory distress syndrome (ARDS), organ failure and death.
At the time of the COLCORONA Trial there was a shortage of reagents for PCR tests and there were restrictions in use of these tests, so that initially in the study diagnosis of probable COVID-19 was through an epidemiological link or if the patient had compatible symptoms.
Results from the COLCORONA Trial were published in May 2021.
- The use of colchicine did NOT statistically significantly reduce the risk of death or hospital admission from COVID-19, when compared to placebo treatment.
- Patients who were diagnosed with COVID-19 by symptoms or epidemiological link were half as likely (3%) to have a primary event compared to patients who had a confirmed diagnosis of COVID-19 using PCR testing (6%).
- For patients who had COVID-19 diagnosis confirmed by PCR test, colchicine use showed a statistically significant benefit on rate of death or hospital admission when compared to placebo.
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RECOVERY Colchicine Trial
- From November 2020 until 4 March 2021 the RECOVERY Trial did a randomised comparison of colchicine compared to usual care in the treatment of COVID-19 in 11,162 patients.
- There was no significant difference in time spent in hospital, risk of needing invasive mechanical ventilation or death when colchicine group was compared to usual care alone.
Is Colchicine an approved medicine by the FDA?
- Yes, colchicine is FDA approved for the indications of gout and familial mediterranean fever (FMF)
- Colchicine may also be used for off-label uses in Behçet syndrome, pseudogout and pericarditis.
What happens next?
There are more clinical trials currently underway using colchicine to treat COVID-19.
We need to wait for more trials to be completed to have sufficient clinical evidence whether or not colchicine reduces the rate of death and complications related to COVID-19.
Related information: COVID-19: Prevention & Investigational Treatments
Bottom line
- Colchicine is a medication that is currently being trialled to treat patients with COVID-19.
- Colchicine is thought to decrease the ‘cytokine storm’ or inflammation that causes complications and death, in patients with COVID-19.
- Colchicine is currently approved by FDA for gout and familial mediterranean fever.
- NIH COVID-19 Treatment Guidelines Panel currently does not recommend the use of colchicine in hospitalized patients. For non hospitalized patients there is insufficient evidence to recommend either for or against the use of colchicine.
References
- Colchicine Coronavirus SARS-CoV2 Trial (COLCORONA) (COVID-19): https://clinicaltrials.gov/ct2/show/NCT04322682
- Effects and safety of long-term use of colchicine on heart disease: https://www.cochrane.org/CD011047/VASC_effects-and-safety-long-term-use-colchicine-heart-disease
- A Randomized Trial of Colchicine for Acute Pericarditis: https://www.nejm.org/doi/full/10.1056/NEJMoa1208536
- Colcrys Professional Medication Information: https://www.drugs.com/pro/colcrys.html
- Comorbidities and multi-organ injuries in the treatment of COVID-19: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30558-4/fulltext
- Heartbeat: Colchicine and heart disease: https://heart.bmj.com/content/102/8/567
- NIH COVID-19 Treatment Guideline for Colchicine: https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/colchicine/
- Colchicine in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial: https://www.medrxiv.org/content/10.1101/2021.05.18.21257267v1
- Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00222-8/fulltext
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Drug information
- Colchicine Information for Consumers
- Colchicine prescribing info & package insert (for Health Professionals)
- Side Effects of Colchicine (detailed)
- Colchicine user reviews (102)
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