The evidence from clinical trials on colchicine and corticosteroids’ effect on COVID-19: a systematic review and meta-analysis

Abstract

Objectives

With no clear end for the outbreak, identifying the drugs that are effective in COVID-19’s management is of utmost importance to reduce the impact on the general population and the healthcare systems.

Methods

This is a systematic review and a meta-analysis evaluating the evidence from clinical trials on the effect of colchicine and corticosteroids against COVID-19. In this review, we have systematically searched five databases [(PubMed, Embase, clinicaltrials.gov, ICTRP, CINAHL (EBSCO)]. Cochrane’s data extraction sheet was used to collect the required information, and RevMan-5.4.1 was used to conduct the meta-analysis and to assess the risk of bias. The review was registered in Prospero (CRD42022299718)

Results

The total number of included studies was 17, with 18,956 participants; the majority were male 12,001. Out of which, 8772 participants were on colchicine, 569 took methylprednisolone, and 64 patients received prednisolone. The meta-analysis has shown that colchicine had no significant effect on reducing the mortality rate among COVID-19 patients [OR 0.98(95% CI 0.90–1.08), p = .70), I²:1%)], corticosteroids have significantly reduced the mortality rates [OR 0.55 (95% CI 0.33–0.91), p = .02, I²:40]. Colchicine did not reduce the incidence of ICU admissions [OR 0.74 (95% CI 0.39–1.40), p = .35, I²:0%], while steroidal drugs significantly reduced the ICU admissions [OR 0.42 (95% CI 0.23–0.78), p = .005, I²:0%]. Unlike steroidal drugs [OR 0.53 (95% CI 0.30–0.95), p = .03, I²:61%], colchicine failed to reduce the need for mechanical ventilation [OR 0.73 (95% CI 0.48–1.10), p = .13, I²:76%]. Steroidal drugs significantly reduced the duration of hospitalization among COVID-19 patients [OR −0.50 (95% CI −0.79–0.21), p = .0007, I²:36%].

Conclusions

The use of colchicine did not significantly reduce the mortality rate, ICU admissions, and mechanical ventilation among COVID-19 patients. Conversely, corticosteroids significantly reduced the mortality rate, ICU admissions, mechanical ventilation, and hospitalization duration among COVID-19 patients.

Keywords:

• Colchicine
• steroids
• COVID-19
• hospitalization
• mortality

Transparency

Declaration of funding

This study received no funding or sponsorship from any entity.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

SASS: Concept and planning, ANB: Protocol formatting and registration, ANB and SASS: Sreening, recruitement of manuscripts, and data extraction. ANB: Statistical analysis, ANB and SASS: Prepared the first draft of the manuscript. SASS: supervised this project. Both authors reviewed and approved the final version of the manuscript

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.