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Rahhal A, Najim M, Aljundi AH, Mahfouz A, Alyafei SM, Awaisu A, Habib MB, Obeidat I, Faisal MM, Alanzi MA, Nair AP, Elhassan A, Al-Dushain A, Abdelmajid AA, Abdelgader AE, Moursi AMA, Alharafsheh AEN, Kamar MRA, Goravey W, Omar AS, Abukhattab M, Khatib MY, Mohamedali MG, AlMaslamani MAR, Alemadi S. Adding colchicine to tocilizumab in hospitalized patients with severe COVID-19 pneumonia: An open-label randomized controlled trial. Medicine (Baltimore) 2022; 101:e30618. [PMID: 36181009 PMCID: PMC9524530 DOI: 10.1097/md.0000000000030843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Colchicine acts upstream in the cytokines cascade by inhibiting the nod-like receptor protein 3 (NLRP3) inflammasome while interleukin 6 (IL-6) receptor antagonists, such as tocilizumab, block the end result of the cytokines cascade. Hence, adding colchicine to tocilizumab with the aim of blocking the early and end products of the cytokines cascade, might reduce the risk of developing cytokine storm. METHODS AND ANALYSIS We aim to conduct an open-label randomized controlled trial to evaluate the efficacy and safety of adding colchicine to tocilizumab among patients with severe COVID-19 pneumonia to reduce the rate of invasive mechanical ventilation and mortality. We will include patients with severe COVID-19 pneumonia who received tocilizumab according to our local guidelines. Enrolled patients will be then randomized in 1:1 to colchicine versus no colchicine. Patients will be followed up for 30 days. The primary outcome is the rate of invasive mechanical ventilation and will be determined using Cox proportional hazard model. DISCUSSION Given colchicine's ease of use, low cost, good safety profile, and having different anti-inflammatory mechanism of action than other IL-6 blockade, colchicine might serve as a potential anti-inflammatory agent among patients with severe COVID-19 pneumonia. This study will provide valuable insights on the use of colchicine in severe COVID-19 when added to IL-6 antagonists. ETHICS AND DISSEMINATION The Medical Research Center and Institutional Review Board at Hamad Medical Corporation in Qatar approved the study protocol (MRC-01-21-299). Results of the analysis will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
- *Correspondence: Alaa Rahhal, Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar (e-mail: )
| | - Mostafa Najim
- Internal Medicine Department, Rochester Regional Health - Unity Hospital, NY, USA
| | | | - Ahmed Mahfouz
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Mhd, Baraa Habib
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Obeidat
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Areeg Elhassan
- Infectious Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | | | | | - Wael Goravey
- Infectious Diseases Department, Hamad Medical Corporation, Doha, Qatar
| | - Amr Salah Omar
- Cardiothoracic Surgery/Cardiac Anaesthesia Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Abukhattab
- Cardiothoracic Surgery/Cardiac Anaesthesia Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Samar Alemadi
- Rheumatology Department, Hamad Medical Corporation, Doha, Qatar
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