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Colchicine for the Treatment of Myocardial Injury in Patients With Coronavirus Disease 2019 (COVID-19)—An Old Drug With New Life?

Educational Objective
To understand how COVID-19 has given Colchicine new life as a form of treatment of myocardial injury
1 Credit CME

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 6 million individuals worldwide, leading to the ongoing coronavirus disease 2019 (COVID-19) pandemic and significant morbidity and mortality. Patients with active myocardial injury (ie, elevated troponin levels) are at a very high risk, with mortality rates reaching as high as 40%.1,2 In particular, the subset of patients with evidence of myocardial injury and underlying cardiovascular disease are at exceedingly high risk, with mortality rates of nearly 70%.1,2 While several mechanisms have been postulated for how SARS-CoV-2 may damage the lungs, heart, and other organs, indirect damage from innate, cellular, and/or humoral immune responses, including a severe cytokine storm, is a leading hypothesis supported by numerous studies reporting significantly elevated inflammatory biomarkers in patients with COVID-19.

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Article Information

Published: June 24, 2020. doi:10.1001/jamanetworkopen.2020.13556

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Rabbani AB et al. JAMA Network Open.

Corresponding Author: Amir B. Rabbani, MD, Division of Cardiology, University of California, Los Angeles, 3500 Lomita Blvd, Ste M100, Torrance, CA 90505 (arabbani@mednet.ucla.edu).

Conflict of Interest Disclosures: None reported.

References
1.
Guo  T , Fan  Y , Chen  M ,  et al.  Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19).   JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1017PubMedGoogle Scholar
2.
Deng  Y , Liu  W , Liu  K ,  et al.  Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study.   Chin Med J (Engl). Published March 20, 2020. doi:10.1097/CM9.0000000000000824PubMedGoogle Scholar
3.
Leung  YY , Yao Hui  LL , Kraus  VB .  Colchicine—update on mechanisms of action and therapeutic uses.   Semin Arthritis Rheum. 2015;45(3):341-350. doi:10.1016/j.semarthrit.2015.06.013PubMedGoogle ScholarCrossref
4.
Imazio  M , Bobbio  M , Cecchi  E ,  et al.  Colchicine in addition to conventional therapy for acute pericarditis: results of the Colchicine for Acute Pericarditis (COPE) trial.   Circulation. 2005;112(13):2012-2016. doi:10.1161/CIRCULATIONAHA.105.542738PubMedGoogle ScholarCrossref
5.
Imazio  M , Cecchi  E , Trinchero  R ; COPPS Investigators.  Colchicine for the prevention of the postpericardiotomy syndrome: the COPPS trial.   Int J Cardiol. 2007;121(2):198-199. doi:10.1016/j.ijcard.2006.08.071PubMedGoogle ScholarCrossref
6.
Tardif  JC , Kouz  S , Waters  DD ,  et al.  Efficacy and safety of low-dose colchicine after myocardial infarction.   N Engl J Med. 2019;381(26):2497-2505. doi:10.1056/NEJMoa1912388PubMedGoogle ScholarCrossref
7.
Deftereos  SG , Giannopoulos  G , Vrachatis  DA ,  et al; GRECCO-19 Investigators.  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.   JAMA Netw Open. 2020;3(6):e2013136. doi:10.1001/jamanetworkopen.2020.13136Google Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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