There is new evidence that a 2,000-year-old drug could offer hope against a modern scourge: COVID-19.
The medicine, called colchicine, is an anti-inflammatory that is taken in pill form. It has long been prescribed for gout, a form of arthritis, and its history dates back centuries. The drug was first obtained from the autumn saffron flower.
Doctors also sometimes use colchicine to treat pericarditis, where the sac around the heart becomes inflamed.
Now, a team of Greek researchers who reported Wednesday at the JAMA Network Open said their small trial suggests that colchicine may help curb severe COVID-19.
105 Greek patients hospitalized in April with COVID-19 participated in the trial. In addition to receiving standard antibiotics and antivirals (but not remdesivir), half of the participants received daily doses of colchicine for up to three weeks, while the other half did not.
The results “suggest a significant clinical benefit of colchicine in hospitalized patients with COVID-19,” according to the team led by Dr. Spyridon Deftereos, a cardiologist at Attikon Hospital in Attiki, Greece.
Specifically, although the condition of seven out of 50 patients who did not receive colchicine “deteriorated clinically” to a severe stage (eg, requiring mechanical ventilation to survive), this was true only for one of the 55 patients who did receive colchicine, investigators said.
In a magazine editorial, a group of US doctors. USA He agreed that the study has limits, but applauded the Greek team for “showing us that an old medicine can still have new life.”
Dr. Amir Rabbani, a cardiologist at the University of California, Los Angeles, and colleagues noted in the editorial that the study size was too small to offer a definitive statement on whether colchicine should be used routinely against COVID-19. .
But they said its effects on certain blood markers of cardiac function, as noted in the new study, suggest that colchicine has anti-inflammatory and anticoagulant effects that could help limit cardiovascular damage caused by COVID-19.
A bigger test is needed, and it’s on its way
Dr. Rajiv Bahl is an emergency medicine physician in Orlando, Florida, who has seen the ravages of severe COVID-19 in patients first-hand. Reading the Greek findings, he noted that colchicine “has also been used to prevent heart conditions like pericarditis and other inflammatory conditions that affect the body.”
Still, the new study is too small, so while “it shows early promise, future studies need to be done before we can incorporate colchicine as a widely used drug to help fight COVID-19,” Bahl said. .
That trial is already underway.
As first reported in April, researchers in the United States and Canada are testing colchicine’s ability to prevent high-risk COVID-19 patients from getting sick enough to land in the hospital.
According to researcher Dr. Priscilla Hsue, a professor of medicine at the University of California, San Francisco (UCSF), “one of the unique aspects is that we are trying to overcome this before people need to be hospitalized.”
Colchicine is the drug of choice for several reasons, Hsue explained: Unlike many drugs that are tested in hospital patients, which are given by infusion or injection, colchicine tablets are easy to take and inexpensive, making them They could easily be used at home. The drug also has a long history of safe use for gout, he added.
Beyond that, Hsue added, a recent trial found that low-dose colchicine benefits people who have recently had a heart attack. Patients who took one tablet daily reduced their risk of more heart complications or strokes in the next two years.
Heart injury is a common problem in people who become seriously ill with COVID-19, at least in part, the researchers suspect, due to a runaway immune system reaction called a “cytokine storm.”
Unique design
Hsue believes that it is worth investigating whether colchicine could help prevent such heart problems.
The North American trial aims to enroll 6,000 newly diagnosed COVID-19 patients who are at increased risk for serious disease, because they are over the age of 69 or have conditions such as heart or lung disease.
To keep these isolated patients at home, the study has an unusual “contactless” design: patients will receive the medication by courier and have follow-up visits by video or phone. The researchers will look at whether the tactic reduces hospitalization and death rates for a month.
Dr. Randy Cron is a professor of pediatrics and medicine at the University of Alabama at Birmingham, and an expert on the “cytokine storm”.
While Cron believes it is prudent to attack cytokine storms in COVID-19, he had some reservations about giving colchicine to people with no signs of severe immune reaction. Could it dampen your immune response against the virus?
“My concern is, could it make the infection worse?” Cron said.
However, Hsue noted the drug’s safety record, noting that the dose administered in the trial will be less than what is commonly used for gout.
In the end, experts say the only way to definitely prove that any drug works for COVID-19 is through clinical trials.
The colchicine study is currently recruiting patients, with UCSF and New York University School of Medicine being the first two US sites. USA Involved.
More information
The World Health Organization has updates on COVID-19.
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