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Haroon MZ, Farooq U, Ashraf S, Zeb S, Gillani SY, Malik S, Ali R, Irshad R, Mehmood Z, Abbas Y, Masood A, Ghafoor A, Khalil AT, Asif H, Khan S, Ujjan ID, Nigar R, Livingstone S, Pascual-Figal DA, Togni S, Allergini P, Riva A, Khan A. Colchicine anti-inflammatory therapy for non-intensive care unit hospitalized COVID-19 patients: results from a pilot open-label, randomized controlled clinical trial. J Physiol Pharmacol 2022; 73. [PMID: 36302537 DOI: 10.26402/jpp.2022.3.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/30/2022] [Indexed: 06/16/2023]
Abstract
Systemic inflammation is a hallmark of severe coronavirus disease-19 (COVID-19). Anti-inflammatory therapy is considered crucial to modulate the hyperinflammatory response (cytokine storm) in hospitalized COVID-19 patients. There is currently no specific, conclusively proven, cost-efficient, and worldwide available anti-inflammatory therapy available to treat COVID-19 patients with cytokine storm. The present study aimed to investigate the treatment benefit of oral colchicine for hospitalized COVID-19 patients with suspected cytokine storm. Colchicine is an approved drug and possesses multiple anti-inflammatory mechanisms. This was a pilot, open-label randomized controlled clinical trial comparing standard of care (SOC) plus oral colchicine (colchicine arm) vs. SOC alone (control arm) in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. Colchicine treatment was initiated within first 48 hours of admission delivered at 1.5 mg loading dose, followed by 0.5 mg b.i.d. for next 6 days and 0.5 mg q.d. for the second week. A total of 96 patients were randomly allocated to the colchicine (n=48) and control groups (n=48). Both colchicine and control group patients experienced similar clinical outcomes by day 14 of hospitalization. Treatment outcome by day 14 in colchicine vs control arm: recovered and discharged alive: 36 (75.0%) vs. 37 (77.1%), remain admitted after 14-days: 4 (8.3%) vs. 5 (10.4%), ICU transferred: 4 (8.3%) vs. 3 (6.3%), and mortality: 4 (8.3%) vs. 3 (6.3%). The speed of improvement of COVID-19 acute symptoms including shortness of breath, fever, cough, the need of supplementary oxygen, and oxygen saturation level, was almost identical in the two groups. Length of hospitalization was on average 1.5 day shorter in the colchicine group. There was no evidence for a difference between the two groups in the follow-up serum levels of inflammatory biomarkers including C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), ferritin, interleukin-6 (IL-6), high-sensitivity troponin T (hs-TnT) and N-terminal pro b-type natriuretic peptide (NT pro-BNP). According to the results of our study, oral colchicine does not appear to show clinical benefits in non-ICU hospitalized COVID-19 patients with suspected cytokine storm. It is possible that the anti-inflammatory pathways of colchicine are not crucially involved in the pathogenesis of COVID-19.
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Affiliation(s)
- M Z Haroon
- Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan
| | - U Farooq
- Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan
| | - S Ashraf
- Department of Pulmonology and Critical Care Division, Khyber Teaching Hospital, Khyber Medical College, Peshawar, Pakistan
| | - S Zeb
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - S Y Gillani
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - S Malik
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - R Ali
- Department of Medicine, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - R Irshad
- Department of Pathology, Ayub Teaching Hospital, Ayub Medical College, Abbottabad, Pakistan
| | - Z Mehmood
- Department of Neurology, Lady Reading Hospital, Peshawar, Pakistan
| | - Y Abbas
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - A Masood
- Department of General Medicine, Lady Reading Hospital, Peshawar, Pakistan
| | - A Ghafoor
- Department of Gastroenterology, Lady Reading Hospital, Peshawar, Pakistan
| | - A T Khalil
- Department of Pathology, Lady Reading Hospital, Peshawar, Pakistan
| | - H Asif
- Department of Pulmonology and Critical Care Division, Khyber Teaching Hospital, Khyber Medical College, Peshawar, Pakistan
| | - S Khan
- Department of Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - I D Ujjan
- Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - R Nigar
- Department of Obstetrics and Gynecology, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - S Livingstone
- School of Medicine, University of Dundee, Dundee, UK
| | - D A Pascual-Figal
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - S Togni
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - P Allergini
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - A Riva
- Research & Development Department, Indena S.p.A, Milan, Italy
| | - A Khan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
- INEOS Oxford Institute for Antimicrobial Research, University of Oxford, Oxford, UK
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