Is colchicine effective as a treatment for COVID-19?

Colchicine is Not Recommended for COVID-19 Treatment

Based on current evidence, colchicine should not be used for the treatment of COVID-19 at any disease stage due to lack of robust evidence supporting its efficacy and potential for adverse effects.

Evidence Against Colchicine Use in COVID-19

Guideline Recommendations

• The European Alliance of Associations for Rheumatology (EULAR) explicitly states there is no robust evidence to support the use of low-dose colchicine at any disease stage of COVID-19 (Level of Evidence 2) 1
• The European Respiratory Society suggests NOT to offer colchicine to patients hospitalized with COVID-19 (conditional recommendation, very low quality of evidence) 1

Key Clinical Trial Evidence

• The RECOVERY trial, the largest and most recent randomized controlled trial (n=11,340), found colchicine was not associated with any reduction in:
  • 28-day mortality (21% in colchicine group vs 21% in usual care group; rate ratio 1.01 [95% CI 0.93-1.10]; p=0.77)
  • Duration of hospital stay (median 10 days in both groups)
  • Risk of progressing to invasive mechanical ventilation or death (25% in both groups) 2

Potential Harms and Concerns

• Significant increase in adverse events with colchicine administration (OR 3.96,95% CI 1.72-9.12), primarily gastrointestinal disturbances 1
• In smaller trials, side effects were reported in 20% of severe COVID-19 patients and 7.5% of moderate COVID-19 patients receiving colchicine 3
• Approximately 73% of side effects were gastrointestinal in nature 3

Conflicting Evidence

While some smaller studies have suggested potential benefits:

• A meta-analysis involving 16,488 patients suggested colchicine reduced mortality (RR 0.35,95% CI: 0.15-0.79) and need for oxygen therapy (RR 0.07,95%CI 0.02-0.27) 4
• Another meta-analysis of 8 studies with 5,778 patients suggested improved outcomes with colchicine (OR 0.43,95% CI 0.34-0.55) 5
• A small RCT (n=160) showed colchicine shortened time to recovery by 5 days in severe COVID-19 and 2 days in moderate COVID-19 3

However, these findings are outweighed by the RECOVERY trial, which is the largest and most methodologically robust study to date.

Clinical Decision Algorithm

1. For non-hospitalized patients with COVID-19:

   • Do not prescribe colchicine (no evidence of benefit) 1

2. For hospitalized patients not requiring oxygen:

   • Do not prescribe colchicine (no evidence of benefit) 1

3. For hospitalized patients requiring oxygen, non-invasive ventilation, or mechanical ventilation:

   • Do not prescribe colchicine (evidence of no benefit from large RCT) 1, 2
   • Instead, consider evidence-based treatments:
     • Systemic glucocorticoids (dexamethasone 6 mg once daily for up to 10 days) 6
     • Consider adding tocilizumab to glucocorticoids in patients who are progressing despite treatment 1, 6

Conclusion

Despite some promising results from smaller studies and meta-analyses, the highest quality evidence from the RECOVERY trial demonstrates no benefit of colchicine in hospitalized COVID-19 patients, while adverse effects remain a concern. Current guidelines consistently recommend against its use for COVID-19 treatment.