tetano
Editor, Senior Moderator
Clin Drug Investig
. 2022 Sep 29.
doi: 10.1007/s40261-022-01201-2. Online ahead of print.
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
José Hernández-Rodríguez[SUP] 1 [/SUP], Julio Durán-Sanclemente[SUP] 2 [/SUP], Sergio Prieto-González[SUP] 3 [/SUP], Olga Araújo[SUP] 4 [/SUP], Teresa Hospital-Vidal[SUP] 3 [/SUP], Georgina Casanovas[SUP] 5 [/SUP], Víctor Sapena[SUP] 5 [/SUP], José Luis Blanco[SUP] 6 [/SUP], Alfonso López-Soto[SUP] 3 [/SUP], FRAGILE-COLCOVID19 Study Group
Collaborators, Affiliations
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.
. 2022 Sep 29.
doi: 10.1007/s40261-022-01201-2. Online ahead of print.
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
José Hernández-Rodríguez[SUP] 1 [/SUP], Julio Durán-Sanclemente[SUP] 2 [/SUP], Sergio Prieto-González[SUP] 3 [/SUP], Olga Araújo[SUP] 4 [/SUP], Teresa Hospital-Vidal[SUP] 3 [/SUP], Georgina Casanovas[SUP] 5 [/SUP], Víctor Sapena[SUP] 5 [/SUP], José Luis Blanco[SUP] 6 [/SUP], Alfonso López-Soto[SUP] 3 [/SUP], FRAGILE-COLCOVID19 Study Group
Collaborators, Affiliations
- PMID: 36173596
- DOI: 10.1007/s40261-022-01201-2
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.