Colchicine to Weather the Cytokine Storm in Hospitalized Patients with COVID-19

Abstract

The repurposing of colchicine for the treatment of COVID-19 was suggested based in its immunomodulatory, anti-inflammatory, and anti-viral properties. We performed a single-center propensity score matched cohort study, including all consecutive COVID-19 patients admitted to a community hospital between 1 March 2020 and 30 May 2020. Patients were stratified according to the receipt of colchicine. The primary endpoint was defined as in-hospital death within 28-days follow-up. Secondary endpoints included favorable change in the Ordinal Scale for Clinical Improvement on days 14 and 28 versus baseline, proportion of patients not requiring supplemental oxygen on days 14 and 28, and proportion of patients discharged by day 28. In total data for 303 PCR positive COVID-19 patients were extracted and 66 patients were included in the 1:1 matched cohort study. At the end of the 28 day follow-up, patients receiving colchicine were approximately five times more likely to be discharged (odds ratio, 5.0; 95% confidence interval, 1.25-20.1; p = 0.023) and when comparing mortality, there were 3 deaths (9.1%) in patients receiving colchicine versus 11 deaths (33.3%) in the groups receiving standard of care (odds ratio, 0.20; 95% confidence interval, 0.05-0.80; p = 0.023). These observations warrant further investigation in large controlled clinical trials.

Keywords: COVID-19; colchicine; coronavirus; cytokine storm; viral pneumonia.

Figure 1

Overview of study data selection and analysis.

Figure 2

Standardized mean difference in covariates included in propensity score matching. The dot plot provides a graphical display of the standardized mean difference in covariates before and after propensity score matching. After matching the differences between groups were similar or improved. O₂ saturation represents the value at baseline or hospital presentation.

Figure 3

Figure (A–D) provide the distribution of WHO OSCI score at baseline and on days 7, 14, and 28. At baseline, only three patients required mechanical ventilation (WHO OSCI score above 6; colchicine = 1, control = 2). The last observation carried forward for each evaluation was used.