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 odds ratio (OR) and hazard ratio (HR) were analyzed separately. Results: Six studies, reporting on 5,033 patients, were included in this review. Across the six studies, COVID-19 patients who had colchicine had a lower risk of mortality - HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.36 (95% CI: 0.17, 0.76). Among the three observational studies, COVID-19 patients who received colchicine had a lower risk of mortality - HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.21 (95% CI: 0.06, 0.71). Among three randomized controlled trials, the summary point estimate suggests a direction toward benefit in mortality that is not statistically significant among patients receiving colchicine versus placebo - OR of 0.49 (95% CI: 0.20, 1.24). Conclusion: Colchicine may reduce the risk of mortality in individuals with COVID-19. Further prospective investigation is warranted to determine the efficacy of colchicine as treatment in COVID-19 patients in various care settings of the disease.

Efficacy and safety of colchicine in COVID-19: a meta-analysis of randomised controlled trials

“…Colchicine is not beneficial in reducing risk of mortality in patients with COVID-19. However, earlier meta-analysis studies done by Chiu et al 13 , Vrachatis et al 16 and Hariyanto et al 14 concluded that colchicine may reduce the mortality risk among patients with COVID-19. A living systematic review and network meta-analysis conducted by Siemieniuk et al 25 concluded that colchicine may reduce mortality and mechanical ventilation in non-severe patients with COVID-19.…”

“…Few systematic reviews conducted earlier on the safety and efficacy of colchicine in COVID-19 management included observational studies in their analysis pool. 13–16 Now, randomised controlled trials (RCTs) are available evaluating the use of colchicine in patients with COVID-19. Hence, this meta-analysis was conducted with an objective to determine the efficacy and safety outcomes in patients with COVID-19 treated with colchicine.…”

Coronavirus Disease 2019 (COVID-19) and Immune-mediated Rheumatic Diseases. Recommendations of the Association of Rheumatologists of Russia

“…Установлено, o n l i n e fi r s t что у пациентов с COVID-19 лечение колхицином приводит к снижению риска госпитализаций (на 25%), потребности в ИВЛ (на 50%) и летальности (на 44%). Данные об эффективности колхицина при COVID-19 подтверждена в метаанализах открытых исследований и РКИ [148]. Другим препаратом, широко применяющимся для лечения ИВРЗ, является тБПВП барицитиниб (БАРИ), механизм действия которого связан с ингибицией Янус-киназ, опосредующей антивирусный и противовоспалительный эффекты этого препарата [149].…”

Immunologic Dysregulation and Hypercoagulability as a Pathophysiologic Background in COVID-19 Infection and the Immunomodulating Role of Colchicine

“…Similar results were reported by Hariyanto et al [ 104 ]. Chiu et al included six studies (3 observational studies and 3 randomized trials) having included 5033 patients and reported mortality risk reduction with colchicine administration (OR 0.36; 95% CI: 0.17–0.76), but this survival benefit was no longer significant when analyzing only randomized trial data (OR 0.49; 95% CI: 0.20–1.24) [ 105 ]. More recent meta-analyses of COVID-19 studies have also reported benefits of colchicine administration on mortality [ 106 , 107 , 108 , 109 ].…”