Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial

• Published in: JAMA health forum 2020-06, Vol.3 (6), p.e2013136
• Main Authors: Deftereos, Spyridon G, Giannopoulos, Georgios, Vrachatis, Dimitrios A, Siasos, Gerasimos D, Giotaki, Sotiria G, Gargalianos, Panagiotis, Metallidis, Simeon, Sianos, George, Baltagiannis, Stefanos, Panagopoulos, Periklis, Dolianitis, Konstantinos, Randou, Efthalia, Syrigos, Konstantinos, Kotanidou, Anastasia, Koulouris, Nikolaos G, Milionis, Haralampos, Sipsas, Nikolaos, Gogos, Charalampos, Tsoukalas, George, Olympios, Christoforos D, Tsagalou, Eleftheria, Migdalis, Ilias, Gerakari, Styliani, Angelidis, Christos, Alexopoulos, Dimitrios, Davlouros, Pericles, Hahalis, George, Kanonidis, Ioannis, Katritsis, Demosthenes, Kolettis, Theofilos, Manolis, Antonios S, Lampros Michalis, Naka, Katerina K, Pyrgakis, Vlasios N, Toutouzas, Konstantinos P, Triposkiadis, Filippos, Tsioufis, Konstantinos, Vavouranakis, Emmanouil, Martinèz-Dolz, Luis, Reimers, Bernhard, Stefanini, Giulio G, Cleman, Michael, Goudevenos, John, Tsiodras, Sotirios, Tousoulis, Dimitrios, Iliodromitis, Efstathios, Mehran, Roxana, Dangas, George, Stefanadis, Christodoulos, on behalf of the GRECCO-19 investigators
• Format: Article
• Language: English
• Subjects: Biomarkers; Clinical deterioration; Clinical outcomes; Clinical trials; Coronaviruses; COVID-19; Hospitalization; Infectious Diseases; Medical treatment; Online Only; Original Investigation; Proteins; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Vital signs
• ISSN: 2574-3805; 2574-3805; 2689-0186
• DOI: 10.1001/jamanetworkopen.2020.13136

Importance Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile. Objective To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design, Setting, and Participants 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. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis. 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. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group (P = .34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL (P = .73), respectively. 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 rankP = .03). Adverse events were similar in the 2 groups, except