One More Weapon

Yet another weapon that appears to be effective in the fight against COVID-19 is a 2,000-year-old drug most often used to treat gout. Colchicine is the most effective medication for rapidly reducing joint inflammation resulting from the precipitation of monosodium urate crystals in certain joints. Although quite effective the drug has some unfortunate side effects, chiefly gastritis and diarrhea. It has been used for centuries, once extracted from the autumn crocus flower. Colchicine has seen a rebirth in the field of cardiology being used to treat some patients with inflammation of the protective sac around the heart (pericarditis). It is also being used in some heart attack patients. The biggest news however is its potential role in treating COVID-19. A small team of Greek researchers recently reported in the Journal of the American Medical Association (JAMA) that colchicine appears to benefit patients with severe COVID-19. In a trial of 105 patients half of the patients received daily doses of colchicine in addition to standard treatment while the other half did not receive colchicine. There was significant clinical benefit in the patients who received colchicine over those who did not receive the drug. Seven patients who did not receive colchicine eventually required mechanical ventilation. Of those who received the colchicine only one needed a ventilator. Although this was a small trial, colchicine was observed to lower certain inflammatory markers of heart function and demonstrated anti-coagulant effects that could be especially beneficial in COVID-19 patients. Larger trials are under way and researchers in the U.S. and Canada are investigating whether colchicine can keep high risk patients out of the hospital.

Low dose colchicine has been used in patients who have had a recent heart attack. The anti-inflammatory and anti-coagulant effects appear to lower the risk of a secondary heart attack or stroke for the next two years. COVID-19 has proven to adversely affect the heart in many patients. Colchicine may prove to control inflammation and protect the heart at the same time. Gilead has begun a large study to evaluate their antiviral drug remdesivir when given by inhalation. Previously the medication was administered intravenously which limited it to inpatients since intravenous access was necessary. Some inpatients were already receiving remdesivir in the form of nebulized treatments. If proven successful on a large scale these treatments could be self-administered at home. Doctors have been reluctant to utilize this form of therapy fearing that the virus would be aerosolized and could be spread to others during the treatment. The number of COVID-19 infections have recently been on the rise, but cure rates are improving and deaths are decreasing. Although the virus continues to persist, largely due to unsafe health practices, we are making progress. Past pandemics did not disappear quickly and we shouldn’t expect this one to either.

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