Publications

Introduction

It is estimated that 3·8 billion people worldwide have been infected with the SARS-CoV-2 virus, which causes COVID-19, by the end of 2021.1 Although only a minority of those infected develop moderate or severe disease, the large number of patients requiring hospital admission has overwhelmed many health-care systems, and an estimated 18 million people died by the end of 2021.2 Vaccination is the most effective way to prevent disease progression and thereby reduce morbidity due to COVID-19, but is not accessible for many people3 and hesitancy has limited uptake.4 Additional affordable, efficacious, safe, and readily available treatments that prevent disease progression and death are needed.

COVID-19 disease progression is characterised by dysregulated inflammation and coagulation activation.5,6 Treatments that target these pathways could help to reduce the need for hospitalisation and prevent complications, including respiratory failure and death. Colchicine is a simple, inexpensive, and widely available oral therapy that targets inflammation.7 Aspirin is effective for prevention and treatment of venous and arterial thrombosis.8–10 In outpatients with COVID-19, one large randomised trial suggested that colchicine might be effective for preventing disease progression.11 Aspirin and oral anticoagulants have undergone randomised evaluation in outpatients with COVID-19 but the trials were stopped early owing to low event rates and provided no evidence of benefit.