Colchicine as monotherapy or in combination for phase 2 treatment
This phase is a crucial time for therapy. It may be important to
continue treatment with antivirals even at this stage, monitoring the
patient’s condition and avoiding adverse reactions due to drug
interactions. Based on clinical and laboratory parameters and
inflammatory markers, a change in colchicine doses is considered.
During phase 2, a practical approach could be based on the use of
colchicine increasing up to 0.5 mg twice daily if the patient is an
adult with a body weight greater than 70 kg. Attention is needed to
avoid the accumulation of toxic doses by monitoring liver and kidney
health conditions and considering all possible interactions between
colchicine and other agents in use.
Another therapeutic approach at this stage could be the use of a 0.5 mg
dose of colchicine (as step 1) in combination with hydroxychloroquine.
From a pharmacodynamic point of view, colchicine and hydroxychloroquine
can act in sinergism modulating two fundamental objectives of
inflammation. Hydroxychloroquine reduces the secretion of
proinflammatory cytokines and in particular TNF by stimulated
monocytes-macrophages and in addition to having antiviral effects,
colchicine acts instead on inflammatory NLP3 as described above. (Figure
1)
The initiation of the use of anti IL6 or anti IL1 or glucocorticoids or
other specific treatments able to interrupt the progression of the
cytokine storm, including the right time to start LMWH or administer
antibiotics, should be considered according to the patient’s clinical
condition.