Colchicine and combination therapy
Colchicine is the drug of choice for family Mediterranean fever
prophylaxis (FMF), in addition to its traditional use as a first-line
anti-gout treatment. Its use in SARS-CoV-2 infection is based on the
anti-inflammatory properties of the drug. Many studies indicate its
powerful synergistic action in the treatment of the cascade of cytokines
at different levels by decreasing inflammation through multiple
mechanisms. The main mechanism of action is to inhibit its
polymerization as tubulin microtubules in neutrophils. Furthermore,
colchicine leads to a significant inhibition of the interaction between
white blood cells and endothelial cells that interfere with their
transmigration. However, the main mechanism of action for CS reduction
in patients with SARS-CoV-2 is probably the inhibition of IL-1, IL-6 and
IL-18 due to its interference with the inflammatory protein complex
NLRP3. Upstream inhibition of inflammation NLRP3 can be considered as a
new approach for the prevention or treatment of SARS-CoV-2 infection.
Several clinical trials are currently moving to investigate the efficacy
of colchicine in patients with SARS-Cov-2 infection, as detailed in
Table 1.