THE CORONAVIRUS CRISIS

Millennial treatment of just three euros per month reduces hospitalizations by 25%, based on preliminary results from a study in Canada, the US, Spain, South Africa, Brazil and Greece

El cardiólogo José Luis López-Sendón, fotografiado este lunes en el Hospital Universitario La Paz, en Madrid.
Cardiologist José Luis López-Sendón, photographed this Monday at the La Paz University Hospital in Madrid. ELMO CALVO

46MANUEL ANSEDE27 JAN 2021 – 08:31 CET

Humanity has lost its capacity for wonder in the last year, but there is still room for surprises. Almost a century and a half ago, in the first winter of 1873, The German Egyptologist Georg Ebers was touring Upper Egypt when he stumbled upon a treasure in the hands of a Christian antiquarian: a papyrus of about 3,500 years old, almost 19 meters long when unrolled, containing all the medical knowledge of the time of Pharaoh Amenofis I. Excited, Ebers bought the papyrus and immediately sent it to the University of Leipzig, where it is still preserved. The now known as Papyrus Ebers described 80 diseases and their possible therapies, including wild saffron as a treatment for swelling. A derivative of this medicinal plant, colchicine, is now one of the great hopes against the new coronavirus.

Colchicine, soon given to newly diagnosed patients, reduces hospitalization by 25%, according to preliminary results from an international trial of more than 4,000 patients in Canada, the US, Spain, South Africa, Brazil and Greece. The drug also appears to cut the need for mechanical ventilation by 50% and covid deaths by 44%, although these figures are based on fewer cases, making it more difficult to draw conclusions. These are data that must also be taken with caution, because it is pending review for publication in a scientific journal. “The benefit is there. And it’s a drug that has a derisory price. A one-month treatment costs about three euros,” says José Luis López-Sendón,cardiologist at the Madrid hospital La Paz and principal investigator of the Spanish branch of the study, with 250 patients.

As the Egyptian papyrus proclaimed 3,500 years ago, colchicine has anti-inflammatory properties. Wild saffron has been used against gout attacks since the time of the Byzantine physician Alejandro de Trales,around the year 600, and colchicine remains a reference treatment against this type of arthritis. The researchers hypothesis is that this well-known anti-inflammatory activity also controls the so-called cytokinestorm, a wild reaction that appears in some patients with covid and can be lethal.

Un fragmento del Papiro Ebers, custodiado en la Universidad de Leipzig (Alemania).
A fragment of the Papyrus Ebers, guarded at the University of Leipzig (Germany). UNIVERSITY OF LEIPZIG

The clinical trial has included more than 4,000 volunteers over the age of 40, with confirmed covid and with some risk factor, such as hypertension, obesity or heart disease. Participants have basically taken one tablet a day for a month, at home. The director of international research, Jean-Claude Tardif,of the Institute of Cardiology in Montreal, Canada, said on 22 January in a statement that colchicine is “the first oral drug in the world whose use could have a significant impact on public health and potentially prevent complications of covid in millions of patients.”

The scientific community is very skeptical of such claims without any published study endoys them, especially after the sound failures of other promising drugs, such as hydroxychloroquine and remdesivir. Cardiologist Alberto Cecconi,however, is optimistic. “Colchicine has been used in medicine for centuries, but it never ceases to amaze. It is a drug that has been rescued from antiquity and is now having more applications”, explains this Italian doctor, from the University Hospital of La Princesa, in Madrid. The chemical formula of colchicine is C22H25NO6: 22 carbon atoms, 25 hydrogen, one nitrogen and six oxygen.

Cecconi, oblivious to the new research, recalls that the same team of Tardif and López-Sendón already published in 2019 another study that suggests that colchicine improves the prognosis of patients after a myocardial infarction, thanks to its powerful anti-inflammatory activity. “The drugs that have shown the greatest benefit against covid are corticosteroids, such as dexamethasone. They’re anti-inflammatory drugs. And it makes a lot of sense that another anti-inflammatory drug, which acts in a different way, is also successful,” says Cecconi, who leads another on-going trial with 250 patients, sponsored by the Spanish Society of Cardiology, to determine whether colchicine can also help hospitalized patients. “Colchicine is like a firefighter who puts out the fire of inflammation that sometimes accompanies the coronavirus. Inflammation can be even worse than the virus infection itself,” the Italian researcher sums up.

Flores de azafrán silvestre en el jardín botánico de la Universidad de Oxford.
Wild saffron flowers in the botanical garden of Oxford University. UNIVERSITY OF OXFORD

In Spain there are nine clinical trials underway to study colchicine as a possible treatment against covid, according to the registration of the Spanish Agency for Medicines and Healthcare Products. Doctors Mar García Sáiz and Carlos Richard, from the Marqués de Valdecilla University Hospital in Santander, conceived another trial in March to investigate the effectiveness of early administration of colchicine in patients over the age of 70, but have only obtained 16 volunteers out of the desired 1,000.

“Recruitment has been dire, especially because of the overhead of primary care and lack of human resources,” says Richard, who applauds the data announced by the Tardif team. “Their results are splendid. It’s a group of absolute solvency. I very much doubt that the results they have advanced are different from those published in a scientific journal,” the researcher says.Researcher Mar García Saiz stresses that you only have to take colchicine under medical supervision

The doctor Mar García Sáiz stresses that colchicine is “a very old drug, very safe and very cheap” and warns of the “danger” of people self-mediterranean. The drug is contraindicated in case of kidney damage, for example, and can also interact negatively with other treatments. Colchicine should be taken under medical supervision, the researcher stresses. The Ministry of Health also included wild saffron seeds in 2004 on the list of plants whose sale to the public is prohibited or restricted due to their toxicity.

A daily tablet of a cheap and safe drug would be a perfect treatment to prevent complications of covid, if promising preliminary results are confirmed. The doctor José Hernández-Rodríguez,internist of the Autoimmune Diseases Service of hospital Clínic de Barcelona, leads another of the on-going trials, this time with 144 patients over 65 years of age and more serious, already admitted. “Tardif’s results fit me a lot. They’re not selling smoke in their press release. I’m a believer,” he says.

Physician Julio Arrizabalaga,scientific director of the Biodonostia Institute of Health Research, leads another small trial in San Sebastian to evaluate the efficacy of colchicine against covid. “It is a cheap, well-tolerated medication, except for some cases of diarrhoea, and its theoretical effect was already known to lessen the cytokine storm. There was only a need to prove it. Tardif’s full scientific study will need to be seen, but as little as this data is confirmed, it would be a medication to use against covid,” he says.

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