On the October 20, 2025, Jama Internal Medicine published the following paper, titled, ‘Effectiveness of Colchicine for the Treatment of Long COVID: A Randomized Clinical Trial.' Dr Charles Shepherd, MEA Hon. Medical Adviser, comments on the findings below.
Summary
- A clinical trial tested colchicine vs. placebo in people with long COVID to see if it improves symptoms and physical function over 52 weeks.
- The study found no significant benefit of colchicine in walking ability, inflammation, or quality of life compared to placebo.
Extracts
Importance: Long COVID is characterized by persistent symptoms after SARS-CoV-2 infection, with inflammation playing a key role in pathogenesis. Colchicine, an established anti-inflammatory agent, may reduce these symptoms by targeting inflammatory pathways.
Objective: To evaluate the superiority of colchicine over placebo in improving functional outcome at 52 weeks from baseline.
Design, Setting, and Participants: This double-blind, 1:1 randomized clinical trial recruited participants with confirmed SARS-CoV-2 infection and persistent symptoms from 8 hospitals in 6 states in India between January 2022 and July 2023. Individuals were eligible if they had functional limitation (Post–COVID-19 Functional Status scale grade 2 or more) and/or elevated inflammatory markers (high-sensitivity C-reactive protein >0.20 mg/dL and/or neutrophil to lymphocyte ratio >5). Outcomes were assessed at 12, 26, and 52 weeks after randomization. Data were analyzed from January to February 2025.
Interventions: Participants were randomly assigned to receive colchicine, 0.5 mg, once or twice daily, based on body weight, or placebo for 26 weeks.
Main Outcomes and Measures: The primary outcome was the change in distance walked during a 6-minute walk test from baseline to 52 weeks. Secondary outcomes included changes in inflammatory markers and patient-reported outcome measures, such as quality of life, anxiety, depression, fatigue, dyspnea, measured using validated instruments.
Results: Of 346 participants included in the modified intention-to-treat analysis, 209 (60.4%) were female, 137 (39.6%) were male, and the mean (SD) age was 46 (12) years. At 52 weeks, there was no difference in mean (SD) change in 6-minute walk test distance between the colchicine and placebo groups (colchicine, 35.5 [19.76] m; placebo, 29.96 [19.83] m; mean difference, 5.59 m; 95% CI, –9.00 to 20.18; P = .45). Similar null findings were seen across all predefined outcomes, except for a small, nonclinically relevant difference in the mean (SD) ratio of forced expiratory volume in 1 second to forced vital capacity (colchicine, −0.02 [0.03]; placebo, −0.06 [0.03]; mean difference, 0.04; 95% CI, 0.02 to 0.07; P = .001).
MEA Comment
Research evidence indicates that following an infection there may be on-going over-activity of the immune system occurring in both ME/CFS and Long Covid.
As this may then result in low level inflammation, various types of anti-inflammatory drugs have been assessed as a possible form of treatment.
The results from clinical trials that have been carried out so far have failed to establish that anti inflammatory drugs are an effective form of treatment for either condition.
This clinical trial, which also failed to report any benefit, involved the use of colchicine – a fairly powerful anti inflammatory drug that is mainly used to reduce inflammation and pain in people who have gout.
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
