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.