COVID19 update, June 25, 2020: Greek colchicine trial; Dr. Campbell on long-term sequelae and home antibody testing

(1) It seems that steroids are not the only low-cost anti-inflammatories that reduce COVID19 aggravation and mortality. In two previous posts, back in April and again last week, I mentioned clinical trials with the ancient anti-inflammatory colchicine. 

Results from a randomized clinical trial in Greece were just published in JAMA (the Journal of the American Medical Association). The sample is small (since fortunately for them, Greece had a pretty mild COVID19 season) but there are some statistically significant results.

http://doi.org/10.1001/jamanetworkopen.2020.13136 

In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece.

Intervention  Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks.

Main Outcomes and Measures  Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale[*], ranging from able to resume normal activities to death.[…]

Results  A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. […] The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = .02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P = .03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003).

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This is a small-sample study, but with definitely a promising result. [Full disclosure: I’ve taken colchicine on and off for gout (its primary indication), for which it is very effective — I have had essentially no side effects from the drug.]

(2) Dr. John Campbell here discusses long-term sequelae for people who survive not-so-mild cases of COVID19.

But at 22:10, he also shows a demonstration of a home antibody testing kit.

 

[*] Elsewhere in the paper, the 7-step ordinal scale is defined as follows:

1, ambulatory, normal activities;

2, ambulatory but unable to resume normal activities;

3, hospitalized, not requiring supplemental oxygen;

4, hospitalized, requiring supplemental oxygen;

5, hospitalized, requiring nasal high-flow oxygen therapy, noninvasive mechanical ventilation, or both;

6, hospitalized, requiring extracorporeal membrane oxygenation, invasive mechanical ventilation, or both;

7, death.