Anti-inflammatory therapy for COVID-19 infection: the case for colchicine

The search for effective COVID-19 management strategies continues to evolve. Current understanding of SARS-CoV-2 mechanisms suggests a central role for exaggerated activation of the innate immune system as an important contributor to COVID-19 adverse outcomes. The actions of colchicine, one of the o...

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Published inAnnals of the rheumatic diseases Vol. 80; no. 5; pp. 550 - 557
Main Authors Reyes, Aaron Z, Hu, Kelly A, Teperman, Jacob, Wampler Muskardin, Theresa L, Tardif, Jean-Claude, Shah, Binita, Pillinger, Michael H
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.05.2021
Subjects
Anti-Inflammatory Agents - therapeutic use
Blood clots
Blood platelets
Clinical trials
Colchicine
Colchicine - therapeutic use
Coronaviruses
COVID-19
COVID-19 Drug Treatment
Cytokine storm
Endothelium
Humans
Immune system
Infections
Inflammation
Innate immunity
Intensive care
Medical personnel
Morbidity
Mortality
Neutrophils
Pathophysiology
Proteins
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Thrombosis
Tumor necrosis factor-TNF
therapeutics
cytokines
chemokines
inflammation
immune system diseases
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Summary:The search for effective COVID-19 management strategies continues to evolve. Current understanding of SARS-CoV-2 mechanisms suggests a central role for exaggerated activation of the innate immune system as an important contributor to COVID-19 adverse outcomes. The actions of colchicine, one of the oldest anti-inflammatory therapeutics, target multiple mechanisms associated with COVID-19 excessive inflammation. While many COVID-19 trials have sought to manipulate SARS-CoV-2 or dampen the inflammatory response once patients are hospitalised, few examine therapeutics to prevent the need for hospitalisation. Colchicine is easily administered, generally well tolerated and inexpensive, and holds particular promise to reduce the risk of hospitalisation and mortality due to COVID-19 in the outpatient setting. Successful outpatient treatment of COVID-19 could greatly reduce morbidity, mortality and the demand for rare or expensive care resources (front-line healthcare workers, hospital beds, ventilators, biological therapies), to the benefit of both resource-replete and resource-poor regions.
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AZR, KAH and JT are joint first authors.
Contributors All authors contributed to conception or design of the work; and drafting the work or revising it critically for important intellectual content; and final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
BS and MHP are joint senior authors.
ISSN:0003-4967
1468-2060
DOI:10.1136/annrheumdis-2020-219174