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High-Dose Colchicine: Key Factor in the Treatment of Morbidly Obese COVID-19 Patients

Mondeshki et al., Cureus, doi:10.7759/cureus.58164
Apr 2024  
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Colchicine for COVID-19
5th treatment shown to reduce risk in September 2020, now with p = 0.00000031 from 56 studies.
Lower risk for mortality, ICU, hospitalization, and recovery.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 111 treatments. c19early.org
Case series of 3 morbidly obese COVID-19 patients, 2 outpatients and 1 hospitalized, showing rapid recovery with a therapeutic regimen including high-dose colchicine (5 mg loading dose followed by 1-3 mg daily maintenance dose). Authors hypothesize that the high colchicine doses are necessary to achieve sufficient intracellular concentrations to inhibit the NLRP3 inflammasome and cytokine storm in COVID-19.
Mondeshki et al., 13 Apr 2024, peer-reviewed, 2 authors. Contact: vmitev@mu-sofia.bg.
This PaperColchicineAll
High-Dose Colchicine: Key Factor in the Treatment of Morbidly Obese COVID-19 Patients
Tsanko Mondeshki, Vanyo Mitev
Cureus, doi:10.7759/cureus.58164
Colchicine has long been known to possess anti-inflammatory effects by inhibiting microtubules, activation and migration of neutrophils, and most importantly, the inflammasome complex found in neutrophils and monocytes. Due to these properties, a number of clinical trials have tested the therapeutic effect of colchicine in COVID-19 patients. One common feature of these studies, however, is the low therapeutic dose used, which may explain the conflicting and disappointing results. Colchicine has the unique property of accumulating in leukocytes, which are primarily responsible for the hyperactivation of the NLRP3 inflammasome and the cytokine storm. The low-dose colchicine used to treat COVID-19 is not sufficient to reach the necessary intracellular concentration for NLRP3 inflammasome inhibition. We have reported our experience with high-dose colchicine, within the approved therapeutic range, in both ambulatory and hospitalized patients, and have shown dramatic cure rates. Here, we present our observation of an excellent therapeutic effect of high-dose colchicine in morbidly obese COVID-19 patients who are at the highest morbidity and mortality risk.
Additional Information Author Contributions All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the work. Concept and design: Vanyo Mitev
References
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Ellulu, Patimah, Khaza'ai, Rahmat, Abed, Obesity and inflammation: the linking mechanism and the complications, Arch Med Sci, doi:10.5114/aoms.2016.58928
Freeman, Swartz, Targeting the NLRP3 inflammasome in severe COVID-19, Front Immunol, doi:10.3389/fimmu.2020.01518
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Who, Obesity, Overweight, None
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Late treatment
is less effective
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