To the Editor: Acute respiratory distress syndrome (ARDS) portends a dismal prognosis in COVID-19 disease, with mortality rates ranging from 65% to 94% in patients requiring intensive care unit level of care and mechanical ventilation. 1 A robust hyperinflammatory response with cytokine release of interleukin-1, interleukin-6, tumor necrosis factor, 2 and an overactivation of the nod-like receptor pyrin domain containing inflammasome3 might be the underlying culprit mechanism for the development of COVID-19-related ARDS. According to these findings, a wellknown nod-like receptor pyrin domain containing inhibitor, colchicine, seems to be a promising treatment for COVID-19 ARDS. 4 Our aim was to conduct an updated systematic review and meta-analysis of randomized clinical trials to assess a potential benefit of colchicine in hospitalized patients with COVID-19 infection.

We performed computerized search of PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane Controlled Trials databases using" colchicine" term combined with the following terms:" COVID-19,"" mortality,"" mechanical ventilation," and" hospital stay." The final article search ended on January 10, 2022. PROSPERO registration has been submitted for the current systematic review (ID 42022303793). We included randomized clinical trials that evaluated the outcomes of colchicine+ usual care versus usual care among hospitalized patients with COVID-19. Studies that reported all-cause mortality, mechanical ventilation requirement, and/or length of hospital stay were included in the analysis. The study design, baseline characteristics, intervention strategies, main outcomes, and other study characteristics were extracted by 2 independent investigators (FJR and LB). Discrepancies were resolved by consensus. The primary outcome of interest was all-cause mortality. Secondary outcomes included mechanical ventilation requirement and length of hospital stay. Potential risks