There is no specific treatment recommended for COVID-19, and no vaccine is currently available. The only treatment is symptomatic, and oxygen therapy that is useful for respiratory impairment. In points with respiratory failure non-invasive and invasive mechanical ventilation may be necessary (12).
Convalescent plasma and or immunoglobulin have been used as alternative resort to improve the survival rate of patients with COVID-19 whose condition continued to deteriorate despite treatment with methylprednisolone pulse therapy (13).
Epidemiologic studies have been shown 5% of infections with COVID-19 characterized by acute respiratory distress syndrome (ARDS), requiring mechanical ventilation. Concerning ARDS treatment; it seems plausible to speculate that the anti-IL6R mAb plays a protective role if given at the time of overly elevated immune response to the virus, thus preventing “anaphylactic toxicity”. Such extreme cytokine reaction is accompanied by infiltration of inflammatory monocytes/macrophages (IMM) into the lung and elevated production of the pro-inflammatory cytokines (IL-1, IL-6, IL-8, CXCL-10, and MCP-1) (14).
Colchicine has been shown to limit IL-1b production as a response to various NLRP3 inflammasome inducers in a dose-dependent form. For example, in the setting of acute coronary syndrome, colchicine was effective in suppressing interleukin IL-1b, IL-18 and IL-6, which was attributed to inflammasome inhibition (15, 16).
Chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2, and reported to be efficient in Chinese COV-19 patients (17).
Our clinical trial study included 100 patients in two randomized groups. The two groups did not differ significantly on underlying diseases. In terms of symptoms, during the follow-up after discharge; fever was significantly lower in the group receiving colchicine (P = 0.02). Although the hospitalized period is significantly different between groups (P = 0.001) and was less in colchicine group. None of the patients died or were readmitted.
In Spyridon et al study (18), about the colchicine effect on cardiac and inflammatory biomarkers in COVID-19 admitted patients. 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 = 0.03). In our study, the level of fever in the colchicine group was significantly lower than in the placebo group (P = 0.02). Moreover in colchicine group dyspnea was subsided more rapidly than the placebo group.
In Mansouri et al study (19); they described the case of a 42 years old, healthy patient with Covid-19 who despite improvement in his respiratory symptoms developed a mild to moderate cytokine release syndrome (CRS) and an associated mono articular gout flare. Since the patient refused admission to the hospital and had stable vital signs, they treated him with a safe anti-inflammatory and non-immunosuppressive therapy. To hit two birds with one stone, they considered colchicine, as it has systemic anti-inflammatory effects and is also effective in gout flare. Unexpectedly, 48 hours after treatment, not only did his ongoing fever and toe pain disappear, he also had significant improvements in his general state of health and all his inflammatory markers including fibrinogen, ferritin, D-dimer, and IL-6 levels normalized.
Due to the inflammatory basis in the COVID-19 that includes cytokine storm syndrome because of excessive synthesis of IL-6 against infection and also due to the anti-inflammatory effects of colchicine on the innate immune system by stabilizing of PMNs; Colchicine seems to be effective in improving systemic COVID-19 symptoms such as fever, which is undoubtedly due to inflammatory biomarkers such as IL-6 and TNF (tumor-necrosis factor). Inhibition of these biomarkers is certainly effective in preventing acute respiratory syndrome and cytokine storm suppression the progressiveness of disease which is the most dangerous sign in COVID-19 (6, 8). However; it is necessary to confirm this idea with further studies.