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

Abstract

Background Unprotected and fragile elderly people in nursing homes experienced the highest mortality rates during the initial coronavirus disease 2019 (COVID-19) pandemic. Objective Our aim was to study the role of two oral anti-inflammatory drugs, colchicine and prednisone, in elderly patients with COVID-19 in geriatric centers. Methods A phase II/III, randomized, controlled, multicenter clinical trial was performed in a geriatric population comparing the efficacy and safety of an oral combination of prednisone (60 mg/day for 3 days) and colchicine (at loading doses of 1–1.5 mg/day for 3 days, followed by 0.5 mg/day for 11 days) with the standard treatment, based on intravenous dexamethasone. Primary endpoints assessed the efficacy in reducing death or the modified endpoint death/therapeutic failure to the study drugs over a 28-day period, while secondary endpoints included safety, laboratory changes, and additional therapies used. Results Fifty-four patients (35 female/19 male) were enrolled, 25 (46.3%) of whom were allocated to the experimental arm and 29 (53.7%) to the control arm. At day 28, no differences in deaths were observed. The combination of mortality or therapeutic failure occurred in 12 (45.13%) patients receiving dexamethasone and 6 (28.13%) patients receiving colchicine/prednisone, resulting in a reduction of risk difference (RD) of − 17% ( p = 0.17), with an average reduction of 39% (risk ratio [RR] 0.61) in patients receiving colchicine/prednisone ( p = 0.25). Control patients received higher amounts of additional glucocorticoids ( p = 0.0095) over a longer time frame ( p = 0.0003). Colchicine/prednisone significantly reduced ferritin levels at day 14, as well as d -dimer and lactate dehydrogenase (LDH) levels at day 28. Adverse events were similar in both groups. Conclusions The combination colchicine/prednisone compared with intravenous dexamethasone has shown a remarkable trend to increase disease survival over a 28-day period in elderly patients requiring oxygen therapy in geriatric centers, without safety issues. Clinical Trial Registry Clinical Trials Registration Number: NCT04492358. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-022-01201-2.

Phytochemicals for mitigating the COVID-19 crisis: evidence from pre-clinical and clinical studies

“…Colchicine administration in moderate to severe COVID-19 patients showed less mortality and a higher discharge rate in comparison to the control [143]. A pilot RCT based on 40 adults with obesity and metabolic syndrome reported that a dosage of 0.6 mg colchicine twice daily for 3 months reduced pro-inflammatory molecules including CRP, IL-6, resistin, along with vascular-related proteins (such as oxidized low-density lipoprotein receptor, phosphodiesterase 5A) [144]. Another clinical trial assessed combination oral therapy of prednisone (60 mg per day for 3 days) and colchicine (1-1.5 mg per day for 3 days and then 0.5 mg per day for 11 days) on 25 patients and 29 patients were chosen as control.…”