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Inokuchi T, Homma T, Kitasato Y, Akiyama M, Chikasue A, Nishii Y, Ban S, Adachi T, Sonezaki A, Masuda H, Kamei H, Takenaka M, Tanaka M, Okamoto M, Hoshino T. Oral Colchicine and Low-Dose Aspirin Combination Therapy for Non-elderly, Non-severe, Early Time From Onset, Adult Outpatients with Coronavirus Disease 2019 (COVID-19) during "The Fifth Pandemic Wave" in Japan. Kurume Med J 2024; 70:39-45. [PMID: 38508737 DOI: 10.2739/kurumemedj.ms7012003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Treatment with antiviral drugs for non-severe, early time from onset, adult outpatients with Coronavirus Disease 2019 (COVID-19) had not been established in 2021. However, some new variants of SARS-CoV-2 had caused rapid exacerbation and hospitalization among non-elderly outpatients with COVID-19, contributing to widespread crises within healthcare systems. METHODS From July to October 2021, we urgently assessed a therapeutic program using oral colchicine (1.0 mg loading dose, followed approximately half a day later by 0.5 mg twice daily for 5 days, and then 0.5 mg once daily for 4 days) and low-dose aspirin (100 mg once daily for 10 days), for non-elderly, non-severe, early time from onset, adult outpatients with COVID-19. To verify its effectiveness, we set loxoprofen as a control arm, and com parison of these two arms was performed. The primary outcomes were hospitalization, criticality, and death rates. RESULTS Thirty-eight patients (23 receiving colchicine and low-dose aspirin [CA]; 15 receiving loxoprofen [LO]) were evaluated. Hospitalization rate was lower in the CA group (1/23; 4.3%) than in the LO group (2/15; 13.3%); however, no significant difference was found between the two groups (p=0.34). No critical cases, deaths, or severe adverse events were found in either group. CONCLUSIONS Our CA regimen did not show superiority over LO treatment. However, our clinical experience should be recorded as part of community health care activities carried out in Kurume City against the unprece dented COVID-19 pandemic.
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Affiliation(s)
| | - Tomoki Homma
- Kurume Physicians Association (Kurume Naikaikai)
- Homma Cardiovascular Clinic
| | - Yasuhiko Kitasato
- Kurume Physicians Association (Kurume Naikaikai)
- JCHO Kurume General Hospital
| | | | | | - Yuuya Nishii
- JCHO Kurume General Hospital
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Shigeki Ban
- Kurume Physicians Association (Kurume Naikaikai)
- Ban Clinic
| | - Takeki Adachi
- Kurume Physicians Association (Kurume Naikaikai)
- Adachi Clinic
| | | | | | | | | | | | | | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
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2
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Tiholov R, Lilov AI, Georgieva G, Palaveev KR, Tashkov K, Mitev V. Effect of increasing doses of colchicine on the treatment of 333 COVID-19 inpatients. Immun Inflamm Dis 2024; 12:e1273. [PMID: 38798123 PMCID: PMC11128776 DOI: 10.1002/iid3.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/27/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Previous research done in Bulgaria demonstrated a fivefold reduction in mortality from COVID-19 with increased doses of colchicine from two hospitals in the country. We report here a further 333 cases of COVID-19 inpatients, treated with different doses of colchicine and its effect on mortality. MATERIALS AND METHODS A case-control comparison from two additional hospitals was conducted between increased doses of colchicine and added bromhexine to standard of care (SOC) versus current SOC. Risk and odds ratio, as well as subgroup analysis, was conducted with newly reported data, alongside aggregate data from all hospital centers to determine the extent of mortality reduction in COVID-19 inpatients. RESULTS There was a clear reduction in the mortality of inpatients with increasing doses of colchicine-between twofold and sevenfold. Colchicine loading doses of 4 mg are more effective than those with 2 mg. Despite these doses being higher than the so-called "standard doses," colchicine inpatients experienced lower mortality than SOC patients (5.7% vs. 19.53%). This mortality benefit was evident in different age subgroups, with a 4-mg loading dose of colchicine proving slightly superior to a 2-mg loading dose. Colchicine led to an overall relative risk reduction of 70.7%, with SOC patients having 3.91 higher odds of death. The safety of the doses was not different than the reported in the summary of product characteristics. CONCLUSION Inpatients in Bulgaria with added colchicine and bromhexine to SOC achieved better clinical and mortality outcomes than those on SOC alone. These results question the World Health Organization-recommended strategy to inhibit viral replication. We posit that our treatment strategy to inhibit the Severe acute respiratory syndrome coronavirus 2 entry into the cell with inhaled bromhexine and the hyperactivated NLRP3 inflammasome with higher doses of colchicine, prevents the development of cytokine storm. The timing of the initiation of treatment seems critical.
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Affiliation(s)
- Rumen Tiholov
- Internal Medicine and Pulmology DepartmentMHAT “Sv Ivan Rilsky”KozloduyBulgaria
| | - Aleksander I. Lilov
- Department of Pneumology and PhthysiatricsSHATPPD “ Sofia district”SofiaBulgaria
| | | | - Kiril R. Palaveev
- Department of Pneumology and PhthysiatricsSHATPPD “ Sofia district”SofiaBulgaria
| | - Konstantin Tashkov
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of PharmacyMedical University—SofiaSofiaBulgaria
| | - Vanyo Mitev
- Department of Medical Chemistry and Biochemistry, Faculty of MedicineMedical University—SofiaSofiaBulgaria
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3
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Liu X, Lv Z, Wang Q, Yu J, Wang J, Zhou Y, Sui M, Hao C, Xue D, Zhang Y. IL1RA mediated the effects of aspirin on COVID-19 severity: A Mendelian randomization study. J Infect 2023; 86:410-411. [PMID: 36690213 PMCID: PMC9852317 DOI: 10.1016/j.jinf.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Xuxu Liu
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhenyi Lv
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiang Wang
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingjing Yu
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing Wang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China,Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province, Harbin Medical University, Harbin, China
| | - You Zhou
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meijuan Sui
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chenjun Hao
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Corresponding authors
| | - Dongbo Xue
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Corresponding authors
| | - Yingmei Zhang
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Corresponding authors
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4
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Matsumura Y, Sugiyama T, Kondo N, Miyahara M, Hanaoka N, Nagashima H, Kasahara Y, Fujiyoshi N, Inada A, Inaba S. Fluid restriction management in the treatment of COVID-19: a single-center observational study. Sci Rep 2022; 12:17339. [PMID: 36243779 PMCID: PMC9569332 DOI: 10.1038/s41598-022-22389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
The relationship between fluid management and the severity of illness, duration of treatment, and outcome of coronavirus disease 2019 (COVID-19) is not fully understood. This study aimed to evaluate whether weight change during hospitalization was associated with COVID-19 severity, length of hospital stay, and route of admission. In this study, we assessed the effectiveness of fluid restriction management in patients with severe COVID-19. COVID-19 patients admitted to our hospital between July 2020 and October 2021 were analyzed. Patients were treated with standard drug therapy based on the Japanese guidelines and respiratory support according to the severity of the disease. Early enteral nutrition, defecation management, and anticoagulation therapy were also administered. Fluid restriction management was performed using furosemide and continuous renal replacement therapy as needed unless hemodynamic instability or hyperlactatemia was present. Patient background, route of admission (ambulance, A; transfer, T), weight at admission and discharge, the severity of illness (oxygen therapy, G1; mechanical ventilation, G2; extracorporeal membrane oxygenation, G3), in-hospital mortality, and length of hospital stay were analyzed. There were 116 subjects: G1 (n = 48), G2 (n = 43), and G3 (n = 25), with ages (median [IQR]) of 58 (47-70), 65 (53-71.5), 56 (51-62) years, 40 (83.3%), 31 (72.1%), and 19 (76.0%) males, respectively. Hospital stays were 4.5 (2-7), 10 (7-16), and 18 (15-26) days, and the in-hospital mortality rates were 0 (0%), 7 (16.3%), and 8 (32%), respectively. Body mass index on admission was 26 (23.1-30.2), 27.1 (22.7-31.1), and 31.5 (27.1-33.1) kg/m2, and weight loss during admission was 1.1 (0-2.9), 4.6 (2.3-5.7), 9.2 (5.6-10.5) kg (P < 0.001, Jonckheere-Terpstra test. Weight loss in the severe group (G2 + G3) was 3.4 (0.5-5.8) kg [A, n = 12] and 5.6 (4.4-9) kg [T, n = 43] [P = 0.026, Mann-Whitney U test]. The lengths of hospital stay were 5 (2-7), 9 (7-15), and 18 (12-26) days [P < 0.001, Jonckheere-Terpstra test]. In our fluid restriction management, patients with severe COVID-19 had significant longer hospital length of stay, weight loss, especially those who were transferred to the hospital.
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Affiliation(s)
- Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan.
| | - Takuya Sugiyama
- Department of Anesthesiology, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Natsuki Kondo
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Masaya Miyahara
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Noriyuki Hanaoka
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Hideaki Nagashima
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Yuki Kasahara
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Naohiko Fujiyoshi
- Department of Intensive Care, Chiba Emergency Medical Center, 3-32-1, Isobe, Mihama, Chiba, Chiba, 261-0012, Japan
| | - Azusa Inada
- Department of Anesthesiology, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Shin Inaba
- Department of Anesthesiology, Chiba Emergency Medical Center, Chiba, Chiba, Japan
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5
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Su W, Miao H, Guo Z, Chen Q, Huang T, Ding R. Associations between the use of aspirin or other antiplatelet drugs and all-cause mortality among patients with COVID-19: A meta-analysis. Front Pharmacol 2022; 13:989903. [PMID: 36278186 PMCID: PMC9581252 DOI: 10.3389/fphar.2022.989903] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction: Whether aspirin or other antiplatelet drugs can reduce mortality among patients with coronavirus disease (COVID-19) remains controversial.Methods: We identified randomized controlled trials, prospective cohort studies, and retrospective studies on associations between aspirin or other antiplatelet drug use and all-cause mortality among patients with COVID-19 in the PubMed database between March 2019 and September 2021. Newcastle–Ottawa Scale and Cochrane Risk of Bias Assessment Tool were used to assess the risk of bias. The I2 statistic was used to assess inconsistency among trial results. The summary risk ratio (RR) and odds ratio (OR) were obtained through the meta-analysis.Results: The 34 included studies comprised three randomized controlled trials, 27 retrospective studies, and 4 prospective cohort studies. The retrospective and prospective cohort studies showed low-to-moderate risks of bias per the Newcastle–Ottawa Scale score, while the randomized controlled trials showed low-to-high risks of bias per the Cochrane Risk of Bias Assessment Tool. The randomized controlled trials showed no significant effect of aspirin use on all-cause mortality in patients with COVID-19 {risk ratio (RR), 0.96 [95% confidence interval (CI) 0.90–1.03]}. In retrospective studies, aspirin reduced all-cause mortality in patients with COVID-19 by 20% [odds ratio (OR), 0.80 (95% CI 0.70–0.93)], while other antiplatelet drugs had no significant effects. In prospective cohort studies, aspirin decreased all-cause mortality in patients with COVID-19 by 15% [OR, 0.85 (95% CI 0.80–0.90)].Conclusion: The administration of aspirin may reduce all-cause mortality in patients with COVID-19.
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Affiliation(s)
- Wanting Su
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - He Miao
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhaotian Guo
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qianhui Chen
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
- *Correspondence: Tao Huang, ; Renyu Ding,
| | - Renyu Ding
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
- *Correspondence: Tao Huang, ; Renyu Ding,
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6
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Rabbani A, Rafique A, Wang X, Campbell D, Wang D, Brownell N, Capdevilla K, Garabedian V, Chaparro S, Herrera R, Parikh RV, Ardehali R. Colchicine for the Treatment of Cardiac Injury in Hospitalized Patients With Coronavirus Disease-19. Front Cardiovasc Med 2022; 9:876718. [PMID: 35783822 PMCID: PMC9247184 DOI: 10.3389/fcvm.2022.876718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The impact of colchicine on hospitalized patients with Coronavirus disease-19 (COVID-19) related cardiac injury is unknown. Materials and Methods In this multicenter randomized controlled open-label clinical trial, we randomized hospitalized adult patients with documented COVID-19 and evidence of cardiac injury in a 1:1 ratio to either colchicine 0.6 mg po twice daily for 30 days plus standard of care or standard of care alone. Cardiac injury was defined as elevated cardiac biomarkers, new arrhythmia, new/worsened left ventricular dysfunction, or new pericardial effusion. The primary endpoint was the composite of all-cause mortality, need for mechanical ventilation, or need for mechanical circulatory support (MCS) at 90 days. Key secondary endpoints included the individual components of the primary endpoint and change in and at least 2-grade reduction in the World Health Organization (WHO) Ordinal Scale at 30 days. The trial is registered with clinicaltrials.gov (NCT04355143). Results We enrolled 93 patients, 48 patients in the colchicine arm and 45 in the control arm. There was no significant difference in the primary outcome between the colchicine and control arms (19 vs. 15%, p = 0.78), nor in the individual components of all-cause mortality (17 vs. 15%, p = 1.0) and need for mechanical ventilation (8 vs. 5%, p = 0.68); no patients in either group required MCS. The change in (-1.8 ± 2.4 vs. -1.2 ± 2.0, p = 0.12) and at least 2-grade reduction (75 vs. 75%, p = 1.0) in the WHO ordinal scale was also similar between groups. Conclusion Patients hospitalized with COVID-19 and evidence of cardiac injury did not benefit from colchicine therapy.
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Affiliation(s)
- Amir Rabbani
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States,*Correspondence: Amir Rabbani,
| | - Asim Rafique
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Xiaoyan Wang
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Campbell
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel Wang
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicholas Brownell
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kenia Capdevilla
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States
| | - Victoria Garabedian
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States
| | - Sandra Chaparro
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States
| | - Raul Herrera
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States
| | - Rushi V. Parikh
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Reza Ardehali
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States
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7
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Drosos AA, Pelechas E, Drossou V, Voulgari PV. Colchicine Against SARS-CoV-2 Infection: What is the Evidence? Rheumatol Ther 2022; 9:379-389. [PMID: 35107804 PMCID: PMC8808271 DOI: 10.1007/s40744-022-00425-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of concern worldwide and a huge challenge for rheumatologists. Indeed, several antirheumatic drugs are currently used at different stages of COVID-19, such as several cytokine inhibitors and colchicine. Colchicine is one of the oldest medicines with potent anti-inflammatory properties. In rheumatic diseases it is widely used for the treatment of gout, calcium pyrophosphate deposition disease, and familial Mediterranean fever. It is also used off-label in cardiology to treat atrial fibrillation, pericarditis, and myocardial infarction. Over the last few years, advances in the understanding of colchicine's mechanism of action and its pharmacology and safety have made colchicine a promising candidate agent for the fight against COVID-19. In this review, we discuss COVID-19 pathophysiology highlighting colchicine's mode of action, its pleiotropic effects on neutrophils, inflammasome inhibition, and its viral activity. Finally, we discuss the main clinical studies dealing with the use of colchicine in COVID-19. Given the large body of evidence that demonstrates its effectiveness, safety, and its simple way of administration, colchicine seems to be a promising drug to reduce the risk of severe COVID-19 disease.
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Affiliation(s)
- Alexandros A. Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Vassiliki Drossou
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
| | - Paraskevi V. Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
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8
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DOĞAN A, KARAKÖK T, GEZER Y. Efficacy of colchicine treatment in COVID-19 patients: A case-control study. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2022. [DOI: 10.25000/acem.1054811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Srivastava R, Kumar A. Use of aspirin in reduction of mortality of COVID-19 patients: A meta-analysis. Int J Clin Pract 2021; 75:e14515. [PMID: 34118111 PMCID: PMC8420464 DOI: 10.1111/ijcp.14515] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/06/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 infection, affecting every one of us from the last year. Emerging reports have indicated thromboembolism in serious cases of COVID-19. The aspirin is useful to reduce mortality of serious patients with acute respiratory distress syndrome without COVID-19. Thus, we have conducted a metanalysis to find out the role of aspirin in the mortality of COVID-19 patients using RevMan 5. A total of 10 studies containing 56 696 COVID-19 patients were found appropriate for quantitative analysis. The quality of articles was assessed using Newcastle-Ottawa scale. The fixed-effect model was used to calculate the odds ratio with 95% confidence interval (CI). The odd ratio was found to be 0.70 [0.63, 0.77] which indicates a lesser likelihood of having death in COVID-19 patients in aspirin group as compared with non-aspirin group. However, no effect 0.00 [-0.04, 0.04] was observed after the exclusion of outliers. Thus, further clinical evidence is required to make valid conclusion.
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Affiliation(s)
- Ritika Srivastava
- Department of Pharmacology and Clinical ResearchDelhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
| | - Anoop Kumar
- Department of Pharmacology and Clinical ResearchDelhi Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, India
- Department of PharmacologySchool of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences & Research University (DPSRU), New Delhi, India
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10
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Vrachatis DA, Papathanasiou KA, Giotaki SG, Raisakis K, Kossyvakis C, Kaoukis A, Kolokathis F, Deftereos G, Iliodromitis KE, Avramides D, Bogossian H, Siasos G, Giannopoulos G, Reimers B, Lansky A, Tardif JC, Deftereos S. Immunologic Dysregulation and Hypercoagulability as a Pathophysiologic Background in COVID-19 Infection and the Immunomodulating Role of Colchicine. J Clin Med 2021; 10:5128. [PMID: 34768648 PMCID: PMC8584586 DOI: 10.3390/jcm10215128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 12/20/2022] Open
Abstract
In 2020, SARS-COV-2 put health systems under unprecedented resource and manpower pressure leading to significant number of deaths. Expectedly, researchers sought to shed light on the pathophysiologic background of this novel disease (COVID-19) as well as to facilitate the design of effective therapeutic modalities. Indeed, early enough the pivotal role of inflammatory and thrombotic pathways in SARS-COV-2 infection has been illustrated. The purpose of this article is to briefly present the epidemiologic and clinical features of COVID-19, analyze the pathophysiologic importance of immunologic dysregulation and hypercoagulability in developing disease complications and finally to present an up-to-date systematic review of colchicine's immunomodulating capacity in view of hindering coronavirus complications.
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Affiliation(s)
- Dimitrios A. Vrachatis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (S.G.G.); (F.K.); (G.S.)
| | - Konstantinos A. Papathanasiou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (S.G.G.); (F.K.); (G.S.)
| | - Sotiria G. Giotaki
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (S.G.G.); (F.K.); (G.S.)
| | - Konstantinos Raisakis
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece; (K.R.); (C.K.); (A.K.); (G.D.); (D.A.)
| | - Charalampos Kossyvakis
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece; (K.R.); (C.K.); (A.K.); (G.D.); (D.A.)
| | - Andreas Kaoukis
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece; (K.R.); (C.K.); (A.K.); (G.D.); (D.A.)
| | - Fotis Kolokathis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (S.G.G.); (F.K.); (G.S.)
| | - Gerasimos Deftereos
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece; (K.R.); (C.K.); (A.K.); (G.D.); (D.A.)
| | - Konstantinos E. Iliodromitis
- Evangelisches Krankenhaus Hagen-Haspe, Clinic for Cardiology and Electrophysiology, 58135 Hagen, Germany; (K.E.I.); (H.B.)
- Department of Cardiology, University of Witten/Herdecke, 58455 Witten, Germany
| | - Dimitrios Avramides
- Department of Cardiology, “G. Gennimatas” General Hospital of Athens, 11527 Athens, Greece; (K.R.); (C.K.); (A.K.); (G.D.); (D.A.)
| | - Harilaos Bogossian
- Evangelisches Krankenhaus Hagen-Haspe, Clinic for Cardiology and Electrophysiology, 58135 Hagen, Germany; (K.E.I.); (H.B.)
- Department of Cardiology, University of Witten/Herdecke, 58455 Witten, Germany
| | - Gerasimos Siasos
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (S.G.G.); (F.K.); (G.S.)
| | - George Giannopoulos
- Medical School, Artistotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | | | - Alexandra Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada;
| | - Spyridon Deftereos
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (S.G.G.); (F.K.); (G.S.)
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11
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Lien CH, Lee MD, Weng SL, Lin CH, Liu LYM, Tai YL, Lei WT, Liu JM, Huang YN, Chi H, Chiu NC, Lin CY. Repurposing Colchicine in Treating Patients with COVID-19: A Systematic Review and Meta-Analysis. Life (Basel) 2021; 11:864. [PMID: 34440608 PMCID: PMC8398430 DOI: 10.3390/life11080864] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) had caused huge health losses worldwide. Several drugs had been applied to treat patients with COVID-19, and repurposing colchicine had been proposed for its anti-inflammatory properties via several pathways. In this systematic review, we evaluated the effects of colchicine treatment. From inception to May 31, 2021, databases, including PubMed, EMbase, medRxiv, and Research Square were searched, and 11 studies were enrolled. A total of 17,205 COVID-19 patients with male predominance (62.9%) were analyzed. Patients with colchicine treatment had a significantly lower risk of mortality (odds ratio (OR): 0.57, 95% confidence interval (CI): 0.38-0.87, I2: 72%; p < 0.01) and a non-significantly lower rate of mechanical ventilation (OR: 0.67, 95%CI: 0.39-1.15). The side effects were mild and not significantly different (OR: 2.03, 95%CI: 0.51-8.09). Subgroup analysis with randomized controlled trials showed no statistically significant difference in the mortality (OR: 0.80, 95%CI: 0.44-1.46, I2: 33%; p = 0.22). In conclusion, our meta-analysis found that colchicine treatment was associated with a significantly lower risk of mortality in patients with COVID-19. However, this benefit was not observed in the subgroup analysis of randomized controlled trials. Further randomized controlled studies are required to confirm the potential benefits of colchicine treatment.
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Affiliation(s)
- Chi-Hone Lien
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
| | - Ming-Dar Lee
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
| | - Shun-Long Weng
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
- Department of Medicine, MacKay Medicine College, New Taipei City 25160, Taiwan; (H.C.); (N.-C.C.)
| | - Chao-Hsu Lin
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu 30010, Taiwan
| | - Lawrence Yu-Min Liu
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
- Department of Medicine, MacKay Medicine College, New Taipei City 25160, Taiwan; (H.C.); (N.-C.C.)
| | - Yu-Lin Tai
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
| | - Wei-Te Lei
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jui-Ming Liu
- Department of Urology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 33004, Taiwan;
| | - Ya-Ning Huang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 10449, Taiwan;
| | - Hsin Chi
- Department of Medicine, MacKay Medicine College, New Taipei City 25160, Taiwan; (H.C.); (N.-C.C.)
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 10449, Taiwan;
| | - Nan-Chang Chiu
- Department of Medicine, MacKay Medicine College, New Taipei City 25160, Taiwan; (H.C.); (N.-C.C.)
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 10449, Taiwan;
| | - Chien-Yu Lin
- Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan; (C.-H.L.); (M.-D.L.); (S.-L.W.); (C.-H.L.); (L.Y.-M.L.); (Y.-L.T.); (W.-T.L.)
- Department of Medicine, MacKay Medicine College, New Taipei City 25160, Taiwan; (H.C.); (N.-C.C.)
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12
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Frohman EM, Villemarette-Pittman NR, Rodriguez A, Glanzman R, Rugheimer S, Komogortsev O, Zamvil SS, Cruz RA, Varkey TC, Frohman AN, Frohman AR, Parsons MS, Konkle EH, Frohman TC. Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease. J Neurol Sci 2021; 426:117463. [PMID: 33971376 PMCID: PMC8055502 DOI: 10.1016/j.jns.2021.117463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology's most important and vulnerable life-preserving body tissues, our broncho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe's potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever "world traveler".
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Affiliation(s)
- Elliot M Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
| | | | - Adriana Rodriguez
- Department of Emergency Medicine, Cook Children's Medical Center, Ft. Worth, TX, United States of America
| | - Robert Glanzman
- Clene Nanomedicine, Inc., Salt Lake City, UT 84121, United States of America.
| | - Sarah Rugheimer
- Department of Physics, University Oxford, Oxford OX1 3PU, UK.
| | - Oleg Komogortsev
- Department of Computer Sciences, Texas State University, San Marcos, TX, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, CA, United States of America.
| | - Roberto Alejandro Cruz
- Department of Neurology, Doctor's Health at Renaissance Health Neurology Institute, United States of America; Department of Neurology, University of Texas Rio Grande Valley School of Medicine, United States of America.
| | - Thomas C Varkey
- Dell Medical School, University of Texas at Austin, United States of America.
| | | | | | - Matthew S Parsons
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, United States of America; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States of America.
| | | | - Teresa C Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
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13
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Martha JW, Pranata R, Lim MA, Wibowo A, Akbar MR. Active prescription of low-dose aspirin during or prior to hospitalization and mortality in COVID-19: A systematic review and meta-analysis of adjusted effect estimates. Int J Infect Dis 2021; 108:6-12. [PMID: 34000418 PMCID: PMC8123385 DOI: 10.1016/j.ijid.2021.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Background This study aimed to investigate whether the active prescription of low-dose aspirin during or prior to hospitalization affects mortality in patients with coronavirus disease 2019 (COVID-19). Aspirin is often prescribed for secondary prevention in patients with cardiovascular disease and other comorbidities that might increase mortality, and may therefore falsely demonstrate increased mortality. To reduce bias, only studies that performed an adjusted analysis were included in this review. Methods A systematic literature search of PubMed, Scopus, Embase and Clinicaltrials.gov was performed, from inception until 16 April 2021. The exposure was active prescription of low-dose aspirin during or prior to hospitalization. The primary outcome was mortality. The pooled adjusted effect estimate was reported as relative risk (RR). Results Six eligible studies were included in this meta-analysis, comprising 13,993 patients. The studies had low-to-moderate risk of bias based on the Newcastle–Ottawa Scale. The meta-analysis indicated that the use of low-dose aspirin was independently associated with reduced mortality {RR 0.46 [95% confidence interval (CI) 0.35–0.61], P < 0.001; I2 = 36.2%}. Subgroup analysis on in-hospital low-dose aspirin administration also showed a significant reduction in mortality [RR 0.39 (95% CI 0.16–0.96), P < 0.001; I2 = 47.0%]. Conclusion Use of low-dose aspirin is independently associated with reduced mortality in patients with COVID-19, with low certainty of evidence.
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Affiliation(s)
- Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia; Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | | | - Arief Wibowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
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14
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Schicchi A, Mégarbane B. Toxicity resulting from colchicine used to treat COVID-19 patients: a new challenge for clinical toxicologists. Clin Toxicol (Phila) 2021; 59:1274-1275. [PMID: 33769172 DOI: 10.1080/15563650.2021.1904141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Azzurra Schicchi
- Poison Control Centre and National Toxicology Information Centre - Toxicology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Maugeri Hospital, Pavia, Italy
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Federation of Toxicology APHP, Lariboisière Hospital, INSERM UMR-S1144, University of Paris, Paris, France
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