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  • Association between treatment with colchicine and improved survival in a single-centre cohort of adult hospitalised patients with COVID-19 pneumonia and acute respiratory distress syndrome

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Epidemiology
Association between treatment with colchicine and improved survival in a single-centre cohort of adult hospitalised patients with COVID-19 pneumonia and acute respiratory distress syndrome
  1. Mirko Scarsi1,2,
  2. Silvia Piantoni3,4,
  3. Enrico Colombo1,2,
  4. Paolo Airó4,
  5. Donata Richini1,2,
  6. Marco Miclini1,2,
  7. Valeria Bertasi2,5,
  8. Marta Bianchi2,5,
  9. Damiano Bottone2,6,
  10. Patrizia Civelli2,5,
  11. Maria-Sofia Cotelli2,5,
  12. Ezio Damiolini2,6,
  13. Gloria Galbassini1,2,
  14. Diego Gatta2,6,
  15. Maria-Laura Ghirardelli1,2,
  16. Roberto Magri2,6,
  17. Paola Malamani1,2,
  18. Monia Mendeni1,2,
  19. Stefano Molinari1,2,
  20. Andrea Morotti2,5,
  21. Luisa Salada2,6,
  22. Marinella Turla2,5,
  23. Angiola Vender7,
  24. Angela Tincani3,4,
  25. Antonio Brucato8,
  26. Franco Franceschini3,4,
  27. Roberto Furloni1,2,
  28. Laura Andreoli3,4
  1. 1 Internal Medicine Department – Hospital of Esine, ASST della Valcamonica, Esine, Lombardia, Italy
  2. 2 COVID Unit – Hospital of Esine, ASST della Valcamonica, Esine, Lombardia, Italy
  3. 3 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Lombardia, Italy
  4. 4 Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Lombardia, Italy
  5. 5 Neurology Unit – Hospital of Esine, ASST della Valcamonica, Esine, Lombardia, Italy
  6. 6 Pneumology Unit – Hospital of Esine, ASST della Valcamonica, Esine, Lombardia, Italy
  7. 7 Hospital Pharmacy – Hospital of Esine, ASST della Valcamonica, Esine, Lombardia, Italy
  8. 8 Department of Biomedical and Clinical Sciences "Sacco", University of Milano, Ospedale Fatebenefratelli, Milano, Italy
  1. Correspondence to Dr Mirko Scarsi, Internal Medicine Department - Hospital of Esine, ASST della Valcamonica, 25050 Esine, Lombardia, Italy; m.scarsi{at}asst-valcamonica.it

Abstract

Objectives The outbreak of COVID-19 posed the issue of urgently identifying treatment strategies. Colchicine was considered for this purpose based on well-recognised anti-inflammatory effects and potential antiviral properties. In the present study, colchicine was proposed to patients with COVID-19, and its effects compared with ‘standard-of-care’ (SoC).

Methods In the public hospital of Esine, northern Italy, 140 consecutive inpatients, with virologically and radiographically confirmed COVID-19 admitted in the period 5–19 March 2020, were treated with ‘SoC’ (hydroxychloroquine and/or intravenous dexamethasone; and/or lopinavir/ritonavir). They were compared with 122 consecutive inpatients, admitted between 19 March and 5 April 2020, treated with colchicine (1 mg/day) and SoC (antiviral drugs were stopped before colchicine, due to potential interaction).

Results Patients treated with colchicine had a better survival rate as compared with SoC at 21 days of follow-up (84.2% (SE=3.3%) vs 63.6% (SE=4.1%), p=0.001). Cox proportional hazards regression survival analysis showed that a lower risk of death was independently associated with colchicine treatment (HR=0.151 (95% CI 0.062 to 0.368), p<0.0001), whereas older age, worse PaO2/FiO2, and higher serum levels of ferritin at entry were associated with a higher risk.

Conclusion This proof-of-concept study may support the rationale of use of colchicine for the treatment of COVID-19. Efficacy and safety must be determined in controlled clinical trials.

  • therapeutics
  • anti-inflammatory agents, non-steroidal
  • antirheumatic agents
  • communicable diseases, imported
  • inflammation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/annrheumdis-2020-217712

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    Footnotes

    • Handling editor Josef S Smolen

    • Twitter @piantoni_silvia, @lauraandreoli80

    • RF and LA contributed equally.

    • Contributors All authors were involved in drafting the article or revising it critically for intellectual content. MS, SP, EC, PA, RF and LA had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design: MS, SP, EC, PA, DR, MMi, AT, FF, RF and LA. Acquisition of data: MS, EC, DR, MMi, VB, MB, DB, PC, M-SC, ED, GG, DG, M-LG, RM, PM, MMe, SM, AM, LS, MT, AV and RF. Analysis and interpretation of data: MS, SP, EC, PA, DR, MMi, AT, AB, FF, RF and LA.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The off-label use of colchicine was supported by the hospital administration as the emergency situation of COVID-19, which was particularly severe in Lombardy with dozens of new patients on a daily basis, had to be managed quickly and amidst shortage of 'standard of care' treatments such as antiviral drugs and hydroxychloroquine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.