OBJECTIVE: This systematic review, with meta-analysis and meta-regression aims to evaluate the effect of colchicine administration on mortality in patients with coronavirus disease 2019 (COVID-19) and factors affecting the association.
METHODS: A systematic literature search using the PubMed, Scopus, and Embase databases were performed from inception of databases up until 3 March 2021. We included studies that fulfill all of the following criteria: 1) observational studies or randomized controlled trials (RCTs) that report COVID-19 patients, 2) reporting colchicine use, and 3) mortality within 30 days. There was no restriction on the age, inpatients or outpatients setting, and severity of diseases. The intervention was colchicine administration during treatment for COVID-19. The control was receiving placebo or standard of care. The outcome was mortality and the pooled effect estimate was reported as odds ratio (OR). Random-effects restricted maximum likelihood meta-regression was performed to evaluate factors affecting the pooled effect estimate.
RESULTS: Eight studies comprising of 5530 patients were included in this systematic review and meta-analysis. There were three RCTs and five observational studies. Pooled analysis showed that colchicine was associated with lower mortality in patients with COVID-19 (OR 0.47 [0.31, 0.72], p = 0.001; I2: 30.9, p = 0.181). Meta-regression analysis showed that the association between colchicine and mortality was reduced by increasing age (OR 0.92 [0.85, 1.00], p = 0.05), but not gender (reference: male, p = 0.999), diabetes (p = 0.376), hypertension (p = 0.133), and CAD (p = 0.354).
CONCLUSION: This meta-analysis indicates that colchicine may reduce mortality in patients with COVID-19. Meta-regression analysis showed that the benefit was reduced as age increases.
As per the meta analysis, the molecule colchicine looks promising but further studies and gained personal experience will tell. However, no guidelines have recommended it, yet.
The search for an effective treatment against cytokine storm has gone through multiple options with biological plausibility. Based on other diseases, colchicine is one option that shows promise. The COLCORONA trial is the only one contributed in the article with an adequate sample size and good design. The rest of the articles are small and observational. The design is heterogeneous. The doses are very varied. The severity of the patients is very diverse. This is an important issue, but one which in the This article does not resolve it. Even with the supposed benefit demonstrated, the enormous number of limitations makes it essential to have more trials in various clinical situations that really demonstrate this benefit, or registries of sufficient quality to change practice.
The paper was well done.