Colchicine use in patients with COVID-19: A systematic review and meta-analysis

Abstract

Introduction Colchicine may inhibit inflammasome signaling and reduce proinflammatory cytokines, a purported mechanism of COVID-19 pneumonia. The aim of this systematic review and meta-analysis is to report on the state of the current literature on the use of colchicine in COVID-19 and to investigate the reported clinical outcomes in COVID-19 patients by colchicine usage. Methods The literature was searched from January 2019 through January 28, 2021. References were screened to identify studies that reported the effect of colchicine usage on COVID-19 outcomes including mortality, intensive care unit (ICU) admissions, or mechanical ventilation. Studies were meta-analyzed for mortality by the subgroup of trial design (RCT vs observational) and ICU status. Studies reporting an risk ratio (RR), odds ratio (OR) and hazard ratio (HR) were analyzed separately. Results Eight studies, reporting on 16,248 patients, were included in this review. The Recovery trial reported equivalent mortality between colchicine and non-colchicine users. Across the other studies, patients who received colchicine had a lower risk of mortality—HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.22 (95% CI: 0.09, 0.57). There was no statistical difference in risk of ICU admissions between patients with COVID-19 who received colchicine and those who did not–OR of 0.26 (95% CI: 0.06, 1.09). Conclusion Colchicine may reduce the risk of mortality in individuals with COVID-19. Further prospective investigation may further determine the efficacy of colchicine as treatment in COVID-19 patients in various care settings of the disease, including post-hospitalization and long-term care.

The Effect of Colchicine on Mortality, Mechanical Ventilation, and Length of Stay in Patients With COVID-19 Infection: An Updated Systematic Review and Meta-analysis of Randomized Clinical Trials

“…Although earlier meta-analysis performed by Chiu et al, 18 Vrachatis et al, 19 Hariyanto et al, 20 Salah et al, 21 Elshafei et al, 22 Golpour et al, 23 and Beran et al 24 concluded that colchicine may reduce the risk of mortality in patients with COVID-19 infection, we found no mortality benefit when adding colchicine to the usual care of hospitalized patients with this type of viral infection. The discrepancy with our results and with the recent meta-analysis performed by Kow et al 25 and Mehta et al 26 could be partially explained by the inclusion of only randomized clinical trials instead of a mixture of observational plus randomized studies.…”

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 ].…”

Biosynthesis Investigations of Terpenoid, Alkaloid, and Flavonoid Antimicrobial Agents Derived from Medicinal Plants

“…The antiviral activity of this alkaloid is attributed to its ability to bind tubulin dimers and inhibit microtubule assembly, which not only promotes anti-inflammatory effects but also makes colchicine a potent mitotic poison [ 154 , 157 ]. In addition, colchicine may inhibit inflammasome signaling and reduce proinflammatory cytokines, which is a purported mechanism of COVID-19 pneumonia [ 158 ].…”