The most prevalent complication of COVID-19 infection is respiratory failure from severe acute respiratory syndrome (SARS), the leading cause of mortality. There is increasing indication that the decompensation in severe COVD-19 infection may be due to a cytokine storm syndrome. This hyperinflammatory syndrome results in a fulminant and fatal hypercytokinemia and multiorgan failure. Approximately 15% of patients with COVID-19 infection are hospitalized and 20-30% of these hospitalized patients require ICU care and/or mechanical ventilation. Overall mortality in hospitalized patients is approximately 20-25%. There is significant interest in therapies that can be given upstream to reduce the rate of mechanical ventilation and thus mortality. We hypothesize that treatment with colchicine in COVID-19 moderate-severe patients may decrease the risk of progression into ARDS requiring increased oxygen requirements, mechanical ventilation, and mortality.
Prospective, completely randomized, open labeled, controlled study. Patients will be
randomized into two groups (A and B). Patients of group A will be treated under what is
considered current standard of care at Maimonides Medical Center while group B patients will
receive colchicine in addition to standard of care.
Treatment arm
In addition to the local standard of care for COVID 19 patients, the patient will receive
colchicine PO as such:
- Loading dose of 1.2 mg followed by 0.6mg after 2 hours if without significant
gastrointestinal symptoms (day 1)
- The next day 0.6mg bid for 14 days or until discharge
Patients who are on HMG-Co A Reductase Inhibitors (atorvastatin, fluvastatin, pravastatin,
simvastatin), fibrates, genfibrozil, amiodarone, dronedarone or digoxin should have the
colchicine dosage reduced to a loading dose of 0.6mg followed by 0.3mg after two hours (day
1) followed by 0.3mg BID for 14 days or until discharge.
If patients have significant gastrointestinal symptoms after loading, the dosage may be
reduced to 0.3mg BID for the rest of the 14 day course or until discharge. If
gastrointestinal symptoms continue, the medication should then be discontinued. Patients who
experience sensory motor neuropathy, or symptoms and laboratory findings consistent with
rhabdomyolysis should prompt immediate discontinuation of the drug. If renal function
deteriorates during the treatment course and CrCl <30ml/min, colchicine should also be
discontinued.
Control arm Usual medical therapy (can include medications such as hydroxychloroquine,
azithromycin)
Patients should NOT receive, Remdesivir, IL-6 inhibitors (Tociluzimab, Sarilumab), JAK
inhibitors, IL-1 inhibitors, or other immunomodulators for COVID-19 before randomization.
Since the primary clinical endpoint is progression of disease, if the patient requires beyond
8L nasal cannula, eg. high flow O2 or mechanical ventilation, the primary clinical endpoint
is met and the above experimental medications will be permitted. To rephrase, the patient
will be allowed, Remdesivir, IL-6 inhibitors and other immunomodulators if then deemed
medically necessary by the treating physician.
Drug: Colchicine
People in the colchine group will be given a starting dose of 1.2 mg followed, by 0.6mg after 2 hours if they do not have significant gastrointestinal symptoms, on day 1. After that, they will take colchicine 0.6mg twice a day for 14 days or until discharged or release from the hospital.
Drug: Usual Care
COVID Patients in this arm will receive usual care COVID19 treatment and will not receive colchine.
- Males and females >=18 years of age
- Willing and able to provide written informed consent prior to performing study
procedures
- Currently hospitalized and requiring medical care for COVID-19
- Significant COVID-19 symptom, or judged by the treating provider to be at high risk of
progression to severe COVID-19 infection
- Significant COVID-19 symptoms are defined by one or more of the following:
1. Dyspnea
2. Respiratory frequency ≥ 30/min
3. Blood oxygen saturation ≤ 93%
- AND one or more of the following: (positive PCR test or positive antibodies) or
(CT/Chest X-ray consistent with COVID19 infection) or (anosmia).
Exclusion Criteria:
- Requirement of oxygen supplementation >8L nasal cannula
- Pregnancy
- Known hypersensitivity to colchicine
- Patient currently in shock or with hemodynamic instability requiring pressors
- History of cirrhosis
- Alanine Aminotransferase (ALT) or aspartate aminotransferase (AST) > 5X upper limit of
normal (ULN)
- Patients with severe renal disease, CrCl <30ml/min
- Patients requiring invasive mechanical ventilation at screening or Clinical estimation
that the patient will require mechanical respiratory support within 24 hours
- Patient is currently taking colchicine for other indications (gout or Familial
Mediterranean Fever)
- Patient received Remdesivir, Sarilumab, Tociluzimab, Lopinavir/Ritonavir or other
immunomodulator given for COVID-19 treatment (Note: Convalescent plasma infusion is
not an exclusion)
- Patient is on (and cannot discontinue) a strong CYP3A4 inhibitor (eg clarithromycin,
indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir,
telithromycin, atazanavir), a moderate CYP3A4 inhbitor (eg diltiazem, verapamil,
fluconazole, amprenavir, aprepitant, fosamprenavir) or a P-gp Inhibitor (eg
cyclosporine, ranolazine)
- Patient is undergoing chemotherapy for cancer
- Patient is considered by the investigator, for any reason, to be unsuitable candidate
for the study
Maimonides Medical Center
Brooklyn, New York, United States
Felix Yang, MD, Principal Investigator
Maimonides Medical Center