Efficacy of colchicine treatment in COVID-19 patients: A case-control study

Abstract

Aim: Various clinical studies have been conducted on many alternative options in treating COVID-19 since the beginning of the pandemic process. This study aimed to investigate the effectiveness of colchicine treatment in patients hospitalized in clinical wards due to COVID-19. Methods: The study was retrospectively planned between October 2020 and October 2021. A total of 110 cases who received colchicine + standard treatment (favipiravir + corticosteroid + anticoagulant + symptomatic treatment) were included in the study group. The control group included randomly selected 220 patients who received only standard treatment. All cases' demographic characteristics, features of antibiotic and corticosteroid treatment, comorbidities, and clinical courses were recorded. Patients who received treatment for less than three days due to COVID-19, patients aged >95 years and <18 years, and those transferred to the clinical wards from the intensive care unit were excluded from the study. The groups were compared regarding treatment failure, including the number of intensive care unit admissions and mortality due to COVID-19 infection. Results: While the mean age was 59.4 years in the study group, it was 65.0 years in the control group (p=0.001). The most common coexisting disease was hypertension (63%). There were significant differences between the groups in the proportions of antibiotic use (p=0.002) and high-dose corticosteroid use (p=0.004). The values of white blood cell count (p=0.003), urea (p=0.029), D-dimer (p=0.021), creatine kinase-myocardial band (p=0.003) and troponin (p<0.001) were statistically different. There was no difference in terms of intensive care unit admission (p=0.174), the mortality rate (p=1.000), and treatment failure (p=0.505). Conclusion: According to the results of our study, colchicine treatment does not affect the prognosis of COVID-19 patients. There is a need for prospective studies investigating the role of colchicine treatment in COVID-19 infections.

Keywords

• COVID-19 virus infection
• colchicine
• mortality rate
• intensive care

COVID-19 hastalarında kolşisin tedavisinin etkinliği: Bir vaka-kontrol çalışması

Öz

Amaç: Pandemi sürecinin başlangıcından bu yana COVID-19 enfeksiyonu tedavisinde birçok alternatif seçenek üzerinde çeşitli klinik çalışmalar yapılmıştır. Çalışmanın amacı, COVID-19 nedeniyle hastaneye yatırılan ve yataklı serviste takip edilen hastalarda kolşisin tedavisinin etkinliğini araştırmaktır. Metot: Çalışma Ekim 2020 – Ekim 2021 tarihleri arasında retrospektif olarak planlandı. Çalışma grubuna kolşisin + standart tedavi (favipiravir + kortikosteroid + antikoagülan + semptomatik tedavi) alan 110 vaka, kontrol grubuna ise sadece standart tedavi alan 220 vaka rastgele dahil edildi. Tüm olguların demografik özellikleri, antibiyotik ve kortikosteroid kullanımı, komorbidite durumları ve klinik seyirleri kaydedildi. COVID-19 nedeniyle üç günden az tedavi görenler, 95 yaş üstü ve 18 yaş altı hastalar ve yoğun bakım ünitesinden servise alınan hastalar çalışma dışı bırakıldı. Gruplar yoğun bakım ünitesine yatış ve mortalite olarak tanımlanan COVID-109 enfeksiyonu tedavi başarısızlığı açısından karşılaştırıldı. Bulgular: Yaş ortalaması olgu grubunda 59,4 yıl ve kontrol grubunda 65,0 yıl idi (p=0,001). En sık görülen komorbidite durumu hipertansiyon (%63) idi. İki grup arasında antibiyotik (p=0,002) ve yüksek doz kortikosteroid kullanımı (p=0,004) açısından anlamlı farklılıklar vardı. Lökosit sayısı (p=0,003), üre (p=0,029), D-dimer (p= 0,021), kreatin kinaz-MB (p=0,003) ve troponin (p<0,001) değerlerinde istatistiksel anlamlı farklılıklar tespit edildi. Ancak yoğun bakım ünitesine yatış (p=0,174) ve ölüm oranı (p=1,000) ve bu iki klinik durum birlikte değerlendirildiğinde tedavi başarısızlığı (p=0,505) iki grup arasında fark izlenmedi. Sonuç: Çalışmamızın sonuçlarına göre kolşisin tedavisinin COVID-19 hastalarının prognozu üzerine etkisi yoktur. COVID-19 enfeksiyonu tedavisinde kolşisin tedavisinin tedavisinin rolünü araştıran prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• COVID-19 virüs enfeksiyonu
• kolşisin
• mortalite oranı
• yoğun bakım

Kaynakça

1. 1. Shetty R, Ghosh A, Honavar SG, Khamar P, Sethu S. Therapeutic opportunities to manage COVID-19/SARS-CoV-2 infection: Present and future. Indian J Ophthalmol. 2020;68:693-702.
2. 2. Zhang W, Zhao Y, Zhang F, Wang Q, Li T, Liu Z, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China. Clin Immunol. 2020;214:108393.
3. 3. Soy M, Keser G, Atagündüz P, Tabak F, Atagündüz I, Kayhan S. Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol. 2020;39:2085-94.
4. 4. Schlesinger N, Firestein BL, Brunetti L. Colchicine in COVID-19: an Old Drug, New Use. Curr Pharmacol Rep. 2020 Jul 18:1-9.
5. 5. Chiu L, Lo CH, Shen M, Chiu N, Aggarwal R, Lee J, et al. Colchicine use in patients with COVID-19: A systematic review and meta-analysis. PLoS One. 2021;16:e0261358.
6. 6. Arrieta O, Rodriguez-Diaz JL, Rosas-Camargo V, Morales-Espinosa D, Ponce de Leon S, Kershenobich D, et al. Colchicine delays the development of hepatocellular carcinoma in patients with hepatitis virus-related liver cirrhosis. Cancer. 2006;107:1852-8.
7. 7. Deftereos SG, Giannopoulos G, Vrachatis DA, Siasos GD, Giotaki SG, Gargalianos P, et al. GRECCO-19 investigators. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Netw Open. 2020;3:e2013136.
8. 8. Lopes MI, Bonjorno LP, Giannini MC, Amaral NB, Menezes PI, Dib SM, Gigante SL, Benatti MN, Rezek UC, Emrich-Filho LL, Sousa BAA, Almeida SCL, Luppino Assad R, et al. Beneficial effects of colchicine for moderate to severe COVID-19: a randomised, double-blinded, placebo-controlled clinical trial. RMD Open. 2021;7:e001455.

9. 9. Pascual-Figal DA, Roura-Piloto AE, Moral-Escudero E, Bernal E, Albendín-Iglesias H, Pérez-Martínez MT, et al. COL-COVID Investigators. Colchicine in Recently Hospitalized Patients with COVID-19: A Randomized Controlled Trial (COL-COVID). Int J Gen Med. 2021;14:5517-26.
10. 10. Brunetti L, Diawara O, Tsai A, Firestein BL, Nahass RG, Poiani G, et al. Colchicine to Weather the Cytokine Storm in Hospitalized Patients with COVID-19. J Clin Med. 2020;9:2961.
11. 11. Vitiello A, Ferrara F. Colchicine and SARS-CoV-2: Management of the hyperinflammatory state. Respir Med. 2021;178:106322.
12. 12. Papadopoulos C, Patoulias D, Teperikidis E, Mouselimis D, Tsarouchas A, Toumpourleka M, et al. Colchicine as a Potential Therapeutic Agent Against Cardiovascular Complications of COVID-19: an Exploratory Review. SN Compr Clin Med. 2020;2:1419-29.
13. 13. Mikolajewska A, Fischer AL, Piechotta V, Mueller A, Metzendorf MI, Becker M, et al. Colchicine for the treatment of COVID-19. Cochrane Database Syst Rev. 2021;10:CD015045.
14. 14. Tardif JC, Bouabdallaoui N, L’Allier PL, Gaudet D, Shah B, Pillinger MH, et al., for the COLCORONA Investigators. Efficacy of Colchicine in Non-Hospitalized Patients with COVID-19. medRxiv 2021.01.26.21250494
15. 15. Lien CH, Lee MD, Weng SL, Lin CH, Liu LY, Tai YL, et al. Repurposing Colchicine in Treating Patients with COVID-19: A Systematic Review and Meta-Analysis. Life (Basel). 2021;11:864.
16. 16. Kevorkian JP, Lopes A, Sène D, Riverline JP, Vandiedonck C, Féron F, et al. Oral corticoid, aspirin, anticoagulant, colchicine, and furosemide to improve the outcome of hospitalized COVID-19 patients- the COCOA-COLA cohort study. J Infect. 2021;82:276-316.
17. 17. Doğan A, Öztürk Çerik H, Gürgen A, Özturan A. The Effect of Prognostıc Factors and Potentıal Treatment Regımens on Fatality Covid-19 Patients. Jurnal Info Kesehatan, 2020;18:113-27.
18. 18. Kokturk N, Babayigit C, Kul S, Duru Cetinkaya P, Atis Nayci S, Argun Baris S, et al. The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients. Respir Med. 2021;183:106433.
19. 19. Fang X, Li S, Yu H, Wang P, Zhang Y, Chen Z, et al. Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. Aging (Albany NY). 2020;12:12493-503.
20. 20. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26:1622-9.
21. 21. T.C. Sağlık Bakanlığı COVID-19 Antisitokin Antiinflamatuar Tedaviler, Koagülopati Yönetimi. (7 Kasım 2020’den alıntı). Şu adresten erişilebilir: URL: https://covid19.saglik.gov.tr/TR66341/antisitokin-antiinflamatuar-tedaviler koagulopati-yonetimi.html
22. 22. RECOVERY Collaborative Group, Horby PW, Campbell M, Spata E, Emberson JR, Staplin N, Pessoa-Amorim G, et al. Colchicine in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. medRxiv 2021.05.18.21257267.