Respir Med . Colchicine and SARS-CoV-2: Management of the hyperinflammatory state

[tetano]

Respir Med


. 2021 Feb 1;178:106322.
doi: 10.1016/j.rmed.2021.106322. Online ahead of print.
Colchicine and SARS-CoV-2: Management of the hyperinflammatory state


Antonio Vitiello[SUP] 1 [/SUP], Francesco Ferrara[SUP] 2 [/SUP]



Affiliations

• PMID: 33550151
• PMCID: PMC7848559
• DOI: 10.1016/j.rmed.2021.106322

Free PMC article

Abstract

The global COVID-19 pandemic is currently underway. In December 2020, the European Agency of Medicine (EMA) licensed the first Sars-CoV-2 vaccine. Therapeutic management of the COVID-19 positive patient should primarily aim to avoid the severe complications and organ injury caused by generalized inflammation caused by a cytokine storm and occurring in the most severe stages of viral infection. Current knowledge of the pathophysiological mechanisms of SARS- CoV-2 suggests a central role for exaggerated activation of the innate immune system as an important contributor to the adverse outcomes of COVID-19. Several studies have shown that blocking the cytokine storm or acting early with prevention of it can be effective; studies are underway to evaluate agents that may be able to reduce this hyperinflammatory state. The search for effective management strategies for COVID-19 continues to evolve. The actions of colchicine, one of the oldest anti-inflammatory therapies, target multiple targets associated with excessive COVID-19 inflammation. Colchicine is easily administered, generally well tolerated, and inexpensive. This article reports the scientific and molecular rationale for the use of colchicine as monotherapy or in combination in the various stages of SARS-CoV-2 infection to modulate and control the inflammatory state. Low-dose colchicine may be considered safe and effective for the treatment and prevention of cytokine storm in patients with SARS-CoV-2 infection, particularly as an adjunctive remedy to other therapeutic agents. Well-organized clinical studies are needed in this direction.

Keywords: Colchicine; Coronavirus; Cytokine; Interleukin; Pneumonia; Sars-cov-2

 

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https://www.reuters.com/article/us-health-coronavirus-science-idUSKBN2A332Q

Colchicine, an anti-inflammatory drug used to treat gout and other rheumatic diseases, reduced hospitalizations and deaths by more than 20% in COVID-19 patients in a large international trial. COVID-19 patients with mild illness and at least one condition that put them at high risk for complications, such as diabetes or heart disease, received either colchicine or a placebo for 30 days. Overall, the risk of hospitalization or death was statistically similar in the two groups. But among the 4,159 patients whose coronavirus infections had been diagnosed with a gold-standard PCR test, death or hospital admission occurred in 4.6% of those on colchicine versus 60% of those who got a placebo.