Repurposing Colchicine for the management of COVID-19: A systematic review and meta-analysis

Abstract

Many anti-inflammatory drugs (including tocilizumab, N-acetylcysteine, and itolizumab) have been repurposed for the management of COVID 19, with variable levels of success. Colchicine achieves anti inflammatory activity through tubulin disruption and the inhibition of leucocyte mediated inflammatory activities (such as the production of superoxide and release of various cytokines), which are central to the pathophysiology of COVID 19. Accordingly, this systematic review and meta analysis provides an assessment of currently available data pertaining to the use of colchicine for the treatment of COVID 19. Three studies (two RCTS and one observational) were included in the review, totaling 402 patients of whom 194 received colchicine. The random effect model showed the overall pooled OR to be 0.32 (95% CI: 0.18 to 0.56) for the primary outcome (clinical deterioration), which was statistically significant (p < 0.0001). Further, there was an increase in adverse effects (diarrhea) with the use of colchicine, as suggested by the pooled OR (OR = 4.56, 95% CI: 2.04 to 10.15, P = 0.0002). Despite the limited number of available studies, a statistically significant reduction of clinical deterioration in COVID 19 patients was revealed. However, there was an increase in adverse effects in the form of diarrhea, which was mild and self limiting. Author contribution and approval: The development of the concept and the preliminary search was carried out by RRM and BMP. Extensive database search, data extraction, and quality assessment were carried out by RRM, SM, and BRM. Any disagreement was resolved by BMP. All the data synthesis and statistical analysis were done by BRM, BMP, and RRM. The manuscript was written by RRM, BRM, BMP, and SD. The final version for publication was approved by all the authors.