Colchicine and COVID19: Will a Press Release Cause More Problems than It Solves?
The response from plant biologists was a unified “YIKES!”
Colchicine? Really? That’s the stuff we use to wreck biology, or at least give its decedents too many chromosomes.
A recent press release exclaimed the therapeutic effects of this regent in the treatment of COVID19. A clinical trial of 6000 planned individuals was performed in a double-blind, randomized, placebo-controlled, multi institutional study. The study was piloted by the Montreal Heart Institute. Other international institutions are also examining its effect in separate clinical trials.
Colchine is derived from the crocus flower, and is best known for its ability to arrest cell division by disrupting the molecular cables that attach to chromosomes. These tiny fibers normally pull half of the chromosomes into each new daughter cell. Colchicine disrupts their formation, meaning one cell gets a heavy load of genetic material.
In plant biology that can be a good thing. Plants with extra sets of chromosomes oftentimes have bigger fruits and flowers, and other production traits. Modern strawberry has four sets, banana three, sugar cane six. No big deal.
But in animal biology there are other applications. Some of the first where in cancer chemotherapy. Clearly colchicine stops cell division in vitro, so perhaps it would hinder growth of rapidly dividing tumor cells. There is some in vivo evidence of this, mostly from animal models.
There is a lot of literature on colchicine, with mixed results from clinical application. One study showed a significant decrease in “all cancers” in male, Taiwanese patients using colchicine to treat gout (Kuo et al., 2015).
Why gout? Gout, arthritis, pericarditis and other inflammatory disorders rely on polymerization of the same microtubules, the tiny intracellular cables that help cells divide. Rearrangements of this cytoskeleton are hallmarks of inflammation.
Inflammation is also an aspect of COVID19’s effects, so testing a therapeutic application was a reasonable hypothesis.
The results from these trials were quite positive, suggesting fewer hospitalizations, decreased need for a ventilator, and less chance of dying from the infection.
That’s great! Or is it?
The information did not come from a peer-reviewed paper or even a preprint. It was a press release, and now many in the public are poking their health care providers for a dose of the miracle stuff (some hoping to pick some up on the way to the anti-vaccine rally).
It puts physicians in a bad place.
The problem arises from the rather strong definitive wording from effects that are merely “approaching statistical significance”
“This major scientific discovery makes colchicine the world’s first oral drug that could be used to treat non-hospitalized patients with COVID19.” — Montreal Heart Institute Press Release, 1/22/21
Are press releases writing checks peer-review can’t cash?
The problem comes from the fact that we do not know why the experiments were terminated early, mostly likely because they met a statistical endpoint. They didn’t discuss adverse effects (which are an issue with colchicine, as the digestive epithelium is affected leading to diarrhea, etc.), confidence intervals, and the results from PCR positives versus others.
In other words, while results may be encouraging, there is not enough here to make an informed clinical recommendation.
Most physicians understand the side effects and should be hesitant to prescribe based on a press release.
On the other hand, this is all patients need to know it works.
And we have now created the conspiracy vortex. Physicians make a good decision, patients make a bad one, and the inability to get the drug/poison is viewed as the dirty work of Big Pharma and Bill Gates.
Like hydroxyquinoline and ivermectin before it, there are legitimate applications for the drug, albeit with scant compelling application in treatment of COVID19.
Unlike those other drugs, colchicine can be a deadly poison at relatively low doses.
Just like before, a press release that jumps the gun causes more problems for physicians, more confusion for the public, and a fertile ground for conspiratorial claims — especially if the results fail to reproduce in other trials or deleterious side effects are noted.
The science communication effort above is the personal view of Dr. Kevin Folta as a private citizen and does not represent the University of Florida, its faculty, staff, or students. Please direct complaints to him directly and not to the university.