Comment on: "Pharmaco-Immunomodulatory Therapy in COVID-19".

The novel severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2) pandemic has literally urged bench and clinical researchers to not only think "out of the box" but also to utilise treatments, especially in early 2020, based only on pathophysiological assumptions rather than data on randomised control trials (RCTs) or at least observational studies [ ]during the first semester of 2020, a vigorous everlasting scientific exchange of information was held often leading to a total reversal of "current best-practice" [ ]a series of RCTs evaluating colchicine have been announced in late March 2020 in clinicaltrials gov for both in-patients and out-patients suffering from COVID-19 [3] [ ]waiting for the results of RCTs, a wide discussion on colchicine clinical aspects was conducted In particular, patients under colchicine treatment had statistically significantly improved time to clinical deterioration, mainly driven by less need for invasive mechanical respiratory support [ ]a potential antithrombogenic effect was observed as colchicine attenuated maximum D-dimer levels [10] Colchicine toxicity initially presents as gastrointestinal symptoms (i e , nausea, vomiting, diarrhea), which may clinically progress into respiratory failure, acute respiratory distress syndrome (ARDS), bone marrow suppression and pancytopenia, rhabdomyolysis, renal failure, metabolic acidosis, and cardiac dysrhythmias [6] Besides pneumonia and ARDS, COVID-19 may cause damage to many other organs, including the liver and kidneys [7]