Colchicine
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Colchicine: From Gout and Familial Mediterranean Fever to Plasmodium falciparum Malaria
One-Sentence Summary
Colchicine is an anti-inflammatory drug originally used to treat gout and familial Mediterranean fever (FMF). The TxGNN model predicts it may be effective for Plasmodium falciparum malaria, but this rests on 0 clinical trials and only 2 indirect preclinical publications, neither of which tests colchicine itself. This is a model prediction with very limited supporting evidence.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Gout, familial Mediterranean fever (the Singapore licence records contain no approved indication text) |
| Predicted New Indication | Plasmodium falciparum malaria |
| TxGNN Prediction Score | 99.60% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 2 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in the data compiled for this report. Based on known information, colchicine binds tubulin and disrupts microtubules. This underlies its anti-inflammatory effect in gout and FMF, including reduced neutrophil activity.
The link to malaria is speculative. Parasite microtubules and drug-efflux biology are plausible targets. However, the two supplied papers study microtubule disruption by curcumin in P. falciparum and pfmdr1 expression in mammalian cells in relation to chloroquine. Neither tests colchicine as an antimalarial.
Colchicine also has a narrow therapeutic index and is cytotoxic, which is a major concern for use as an anti-infective.
Other predictions in the list (ranks 2–10) are also weak. The FMF (autosomal dominant) entry is essentially an existing indication, not true repurposing. Most others (for example dermatofibrosarcoma protuberans, sitosterolemia and mastocytosis) have no trials or literature.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 23505424 | 2013 | Preclinical (in vitro) | PLoS One | Curcumin (not colchicine) disrupts P. falciparum microtubules |
| 7511206 | 1994 | Preclinical (cell-based) | Mol Cell Biol | pfmdr1 expression in mammalian cells increases chloroquine susceptibility; colchicine not tested |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN15572P | Colchicine Halewood Tablet 500 mcg | Tablet | Not stated in the available data |
| SIN12301P | Colcitex Tablet 0.6 mg | Tablet | Not stated in the available data |
Cytotoxicity
Colchicine is not a conventional anticancer drug, but it is an antimitotic, cytotoxic-type agent. The data compiled for this report contain no formal cytotoxicity classification, so please refer to the package insert warnings and precautions.
| Item | Content |
|---|---|
| Myelosuppression Risk | Relevant: knowledge-graph contraindications include neutropenia, leukopenia, agranulocytosis, thrombocytopenia and aplastic anaemia |
| Monitoring Items | CBC with differential, liver and renal function, muscle symptoms (myopathy and rhabdomyolysis are listed concerns) |
Safety Considerations
- Contraindications (knowledge-graph based, not label text):
- Liver failure and impaired renal function
- Blood disorders: haematologic disease, thrombocytopenia, leukopenia, agranulocytosis, neutropenia (including congenital forms) and aplastic anaemia
- Muscle disorders: myopathy, rhabdomyolysis and familial periodic paralysis
- Gastrointestinal disorders: peptic ulcer disease and diarrhoeal disease
- Acute urate nephropathy
- Drug Interactions (100 interactions found; examples below):
- Major: clarithromycin, cobicistat, aprepitant, rolapitant, eliglustat, deferiprone, rosuvastatin and simvastatin
- Moderate: cimetidine, metronidazole, tinidazole, miconazole, chloroquine, ticagrelor, deferasirox, fostamatinib, eluxadoline, benznidazole, disulfiram and strontium-89 chloride
Note that chloroquine, a standard antimalarial, is a moderate interaction with colchicine. Package insert warnings were not available, so please refer to the package insert for the full safety information.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction is supported only by a high model score. There are no clinical trials, and the two papers do not test colchicine against malaria. Colchicine's narrow therapeutic index and haematologic toxicity make an anti-infective use hard to justify without direct evidence. Established antimalarials are available.
To proceed, the following is needed:
- In vitro activity data for colchicine against P. falciparum, including resistant strains, with selectivity versus host-cell toxicity
- Animal efficacy and safety data at tolerable doses
- Mechanism of action data to confirm the parasite-specific target
- Singapore package insert warnings and contraindications
- Review of the interaction with chloroquine and other antimalarials
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.