Dear colleagues,
Many of you have seen recent press releases touting the potential benefit of colchicine in outpatient management of COVID-19 (COLCORONA trial). The Collège des médecins and the Ordre des pharmaciens du Québec have issued cautionary statements until further data is available.
The Antimicrobial Stewardship Program team reviewed the preliminary trial data posted on a pre-print server on Jan 27th, 2020. The absolute risk reduction in hospitalization or death attributed to colchicine noted in this trial was small and statistically non-significant (hospitalization in 101 (4.7%) in the colchicine group vs 128 (5.8%) in the placebo group; odds ratio 0.79 with a 95% confidence interval 0.61 – 1.03). Overall, mortality was rare in this outpatient population (5 (0.2%) deaths in the colchicine group vs 9 (0.4%) in the placebo group, OR 0.56; 95% CI 0.19 – 1.66). However, pulmonary emboli were increased in the colchicine group compared to the placebo group (11 (0.5%) vs. 2 (0.1%), p=0.01). Based on numbers from sub-group analyses, approximately 71 patients (95% CI 36 – 200) would need to be treated each for a duration of 28 days to prevent one hospitalization, with a drug that has a narrow therapeutic index (significant risk of toxicity) and multiple drug-drug interactions (with macrolide antibiotics, amiodarone, and others).
Because of the uncertain benefit, the need for follow-up for toxicity effects and our current context of “délestage” of outpatient clinics, at this time we do not recommend routine therapy of COVID-19 cases with colchicine in ambulatory and ER patients. We will of course continue to review scientific evidence as it emerges and will update our treatment guidelines accordingly.
MUHC - Antimicrobial Stewardship Program