Repurposing of colchicine: critical examination of clinical trials and scoping review

PURPOSE: Drug repurposing represents a cost-effective and time-efficient strategy to expand therapeutic treatment options. Colchicine, traditionally used for gout and familial Mediterranean fever, has gained attention as a candidate for diverse conditions. This study aimed to provide a comprehensive and critical overview of clinical trials on colchicine repurposing, with particular focus on reliability, significance, and safety outcomes. METHODS: A structured search of clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) was completed on July 07 2026. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline, PubMed and Scopus were searched using the term "colchicine AND repurposing". RESULTS: 40 clinical trials were included. Nine addressed COVID-19, 26 cardiovascular conditions or related interventions, and five with other indications. Evidence in COVID-19 was inconsistent. Cardiovascular evidence was strong for chronic coronary artery disease and prevention after myocardial infarction. Findings in acute coronary syndromes, percutaneous coronary intervention, surgery and heart failure were mixed and often limited to surrogate endpoints. Other indications did not observe a significant benefit. Most frequent adverse effects were gastrointestinal, particularly diarrhoea. Increased non-cardiovascular mortality in individual trials highlights toxicity potential. CONCLUSION: Current evidence most consistently supports colchicine for secondary cardiovascular prevention in established coronary disease. No reliable evidence is found for benefit across broader cardiovascular conditions, COVID-19 or other indications. A narrow therapeutic index and high drug-interaction potential necessitate careful patient selection and monitoring. Well-powered and methodologically robust clinical trials are required to investigate and confirm potential benefits.