The Coronavirus disease 2019 (COVID-19) pandemic has robustly affected the global healthcare and economic systems and it was caused by coronavirus-2 (SARS-CoV-2). The clinical presentation of the disease ranges from a flu-like illness to severe pneumonia and death. Till September 2022, the cumulative number of cases exceeded 600 million worldwide and deaths were more than 6 million. Colchicine is an alkaloid drug that is used in many autoinflammatory conditions e.g., gout, familial Mediterranean fever, and Behçet’s syndrome. Colchicine inhibits the production of superoxide and the release of interleukins that stimulate the inflammatory cascade. Colchicine decreases the differentiation of myofibroblast and the release of fibrotic mediators including transforming growth factor (TGF-β1) that are related to the fibrosis. Moreover, colchicine has been used to traet viral myocarditis caused by CMV or EBV, interstitial pneumonia, and pericarditis resulting from influenza B infection. Additionally, colchicine is considered safe and affordable with wide availability. The aim of the current study was to assess the evidence of colchicine effectiveness in COVID-19 treatment. A comprehensive review of the literature was done till May 2022 and yielded 814 articles after ranking the articles according to authors and year of publication. Only 8 clinical trials and cohort studies fulfilling the inclusion criteria were included for further steps of data collection, analysis, and reporting. This meta-analysis involved 16,488 patients; 8146 patients in the treatment group and 8342 patients in the control group. The results showed that colchicine resulted in a significant reduction in the mortality rate among patients received colchicine in comparison with placebo or standard care (RR 0.35, 95%CI: 0.15–0.79). Colchicine resulted in a significant decrease in the need for O2 therapy in patients with COVID-19 (RR 0.07, 95%CI 0.02–0.27, P = 0.000024). However, colchicine had no significant effect on the following outcomes among COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation, and hospital discharge rate. Among the PCR confirmed COVID-19 patients, colchicine decreased the hospitalization rate (RR 0.75, 95%CI 0.57–0.99, P = 0.042). However, colchicine had no effect on mortality and the need for mechanical ventilation among this subgroup. Colchicine caused a significant clinical improvement among COVID-19 patients as compared with the standard care or placebo, in terms of the need for O2, and mortality. This beneficial effect could play a role in the management of COVID-19 especially severe cases to decrease need for oxygen and to decrease mortality among these patients.

中文翻译：

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秋水仙碱在 COVID-19 治疗中的作用：荟萃分析

2019 年冠状病毒病 (COVID-19) 大流行严重影响了全球医疗保健和经济系统，它是由冠状病毒 2 (SARS-CoV-2) 引起的。该疾病的临床表现包括从流感样疾病到严重肺炎和死亡。截至2022年9月，全球累计病例数超过6亿，死亡人数超过600万。秋水仙碱是一种生物碱药物，用于治疗多种自身炎症，例如痛风、家族性地中海热和白塞氏综合征。秋水仙碱抑制超氧化物的产生和刺激炎症级联反应的白细胞介素的释放。秋水仙碱减少肌成纤维细胞的分化和纤维化介质的释放，包括与纤维化相关的转化生长因子（TGF-β1）。此外，秋水仙碱已被用于治疗CMV或EBV引起的病毒性心肌炎、间质性肺炎和乙型流感感染引起的心包炎。此外，秋水仙碱被认为是安全且负担得起的，并且具有广泛的可用性。本研究的目的是评估秋水仙碱在治疗 COVID-19 中的有效性证据。截至 2022 年 5 月，对文献进行了全面审查，根据作者和出版年份对文章进行排序后，共产生了 814 篇文章。只有 8 项符合纳入标准的临床试验和队列研究被纳入进一步的数据收集、分析和报告步骤。这项荟萃分析涉及 16,488 名患者；治疗组8146例患者，对照组8342例患者。结果表明，与安慰剂或标准治疗相比，秋水仙碱可显着降低接受秋水仙碱治疗的患者的死亡率（RR 0.35，95% CI：0.15-0.79）。秋水仙碱导致 COVID-19 患者对 O2 治疗的需求显着减少（RR 0.07，95% CI 0.02–0.27，P = 0.000024）。然而，秋水仙碱对 COVID-19 患者的以下结果没有显着影响：住院需要、入住 ICU、人工通气和出院率。在 PCR 确诊的 COVID-19 患者中，秋水仙碱降低了住院率（RR 0.75，95% CI 0.57-0.99，P = 0.042）。然而，秋水仙碱对该亚组的死亡率和机械通气的需求没有影响。与标准治疗或安慰剂相比，秋水仙碱使 COVID-19 患者的 O2 需求和死亡率出现显着的临床改善。这种有益效果可以在 COVID-19（尤其是重症病例）的管理中发挥作用，以减少对氧气的需求并降低这些患者的死亡率。