RECOVERY: No evidence for colchicine benefit in COVID-19
medwireNews: Colchicine, an anti-inflammatory drug commonly used to treat gout and pericarditis, does not improve outcomes for people hospitalized with COVID-19, RECOVERY trial data show.
Writing in The Lancet Respiratory Medicine, Peter Horby (RECOVERY Central Coordinating Office, Oxford, UK) and co-authors say: “There is no good evidence that colchicine treatment is of clinical benefit for adults hospitalised with COVID-19 compared with current usual care.”
They found that the 28-day mortality rate among 11,340 adults (mean age 63 years) hospitalized with clinically suspected or laboratory-confirmed SARS-CoV-2 infection was 21% regardless of whether they were randomly assigned to receive usual care alone (n=5730) or in combination with colchicine (n=5610).
Those in the colchicine group were given an initial dose of 1 mg followed by 500 μg 12 hours later and then twice daily thereafter for 10 days or until discharge. This frequency was halved for participants receiving a moderate CYP3A4 inhibitor such as diltiazem, those with an estimated glomerular filtration rate below 30 mL/min per 1.73m2, and those with an estimated bodyweight of less than 70 kg.
At the time of randomization, participants were a median of 9 days from symptom onset and similar proportions in each group were receiving other treatments for COVID-19, including corticosteroids (87%), remdesivir (23%), and tocilizumab or sarilumab (13%).
Further analyses showed that there was no significant difference in 28-day mortality risk between individuals who did and did not receive colchicine when stratified by age, sex, ethnicity, symptom duration, level of respiratory support at randomization, and use of corticosteroids.
Moreover, there was no significant difference between the two arms in the median time to discharge alive, which was 10 days in both groups, nor in the proportion of patients discharged from hospital alive within 28 days, at an identical 70% with and without colchicine.
Finally, the investigators found no significant difference in the proportion of patients who were not on invasive mechanical ventilation at baseline who subsequently met the composite endpoint of invasive mechanical ventilation or death, at 25% in both groups.
Horby and co-authors say their findings suggest “that the anti-inflammatory properties of colchicine are either insufficient to produce a meaningful reduction in mortality risk or are not affecting the relevant inflammatory pathways in moderate-to-severe COVID-19.”
They add: “It is possible that a longer duration of therapy might have provided benefit, but most participants had stopped colchicine before 10 days either because of death, discharge from hospital, or at the discretion of the treating clinician.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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