The U.S. Centers for Disease Control and Prevention (CDC) has not yet weighed in on the use of colchicine in non-hospitalized patients. The CDC’s most recent COVID-19 update on colchicine is from June 2020 and describes data from hospitalized patients.2
Dr. Pillinger thinks the study’s findings have been ignored because of the success of the COVID-19 vaccines. “We thought the problem was licked,” he says.
Unfortunately, the high rate of vaccine hesitancy and the spread of the delta variant means individuals are becoming infected with COVID-19 and suffering complications. Many of these patients, especially men, may benefit from treatment with colchicine.
“It’s a generally safe drug,” says Dr. Pillinger, adding, “The main problem is diarrhea.” Diarrhea was reported in 13.7% of patients in the study’s treatment group and 7.3% of of patients in the placebo group. However, Dr. Pillinger notes that, because colchicine is easy to stop, if the diarrhea becomes intolerable, the patient can discontinue treatment.
The treatment group had a greater incidence of pulmonary embolism than the placebo group (0.5% vs. 0.1%), but the pulmonary emboli did not necessitate mechanical ventilation or lead to death. Additionally, the physicians considered the pulmonary emboli to be unrelated to the study medication. Dr. Pillinger believes the pulmonary emboli were likely an artifact of how the study captured data.
In addition to being safe, Dr. Pillnger emphasizes colchicine is “dirt cheap.” In the U.S., the cost of 30 days of treatment is approximately $150. This amount compares favorably to the cost of one day of hospitalization, which can be $10,000.
Backstory
“Colchicine is one of the oldest drugs we rheumatologists have,” says Dr. Pillinger. Colchicine, originally isolated from the autumn crocus (Colchium autumnale) which first grew in Asia Minor, has been used medicinally for 2,000 years. It was first described as a treatment for rheumatism and swelling in an Egyptian medical papyrus, and Hippocrates later proposed it as a gout remedy.3 Jason and the Argonauts went to Colchis to capture the Golden Fleece, and according to Dr. Pillinger, some historians have proposed the Golden Fleece was the autumn crocus. Colchicine made its way to the U.S. when Benjamin Franklin brought it back from France to treat his gout. (For more information about colchicine, see “Colchicine: An Ancient Drug with Modern Uses.”)
The U.S. Food & Drug Administration (FDA) has approved colchicine to treat or prevent gout in adults, as well as to treat the genetic condition familial Mediterranean fever. It has been used successfully to reduce the inflammation associated with gout and cardiovascular conditions. However, it’s not a potent immunosuppressant—which Dr. Pillinger says is a potential advantage in its use to treat COVID-19.4
