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.