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0 0.5 1 1.5 2+ Death/ICU 55% Improvement Relative Risk Death/ICU (b) -68% Metformin for COVID-19  Al-Salameh et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 97 patients in France Lower death/ICU with metformin (p=0.04) Al-Salameh et al., Diabetes & Metabolism, Nov 2021 Favors metformin Favors control

The association between metformin treatment and COVID-19 outcomes according to metformin continuation during hospitalisation

Al-Salameh et al., Diabetes & Metabolism, doi:10.1016/j.diabet.2021.101297
Nov 2021  
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Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020
*, now known with p < 0.00000000001 from 88 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,100+ studies for 60+ treatments.
Retrospective 140 diabetic patients in France, showing lower mortality for patients where metformin use was continued after hospitalization.
risk of death/ICU, 55.5% lower, RR 0.45, p = 0.04, treatment 9 of 47 (19.1%), control 22 of 50 (44.0%), NNT 4.0, adjusted per study, odds ratio converted to relative risk, metformin continued, multivariable.
risk of death/ICU, 68.4% higher, RR 1.68, p = 0.02, treatment 34 of 43 (79.1%), control 22 of 50 (44.0%), adjusted per study, odds ratio converted to relative risk, metformin discontinued, multivariable.
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Al-Salameh et al., 30 Nov 2021, retrospective, France, peer-reviewed, 4 authors.
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Abstract: Diabetes & Metabolism 47 (2021) 101297 Available online at ScienceDirect Original article The association between metformin treatment and COVID-19 outcomes according to metformin continuation during hospitalisation Abdallah Al-Salameha,b,*, Youssef Bennisc,d, Bertrand Carioue, Jean-Daniel Lalaua,b,* a Department of Endocrinology- Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France PeriTox, UMR_I 01, University of Picardie Jules Verne, Amiens, France Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France d MP3CV Laboratory, UR UPJV 7517, University of Picardie Jules Verne, Amiens, France e ^pital Guillaume et Rene Laennec, 44093 Departement d’Endocrinologie, Diabetologie et Nutrition, l'institut du thorax, Inserm, CNRS, UNIV Nantes, CHU Nantes, Ho Nantes Cedex 01, France b c A R T I C L E I N F O Article history: Received 25 August 2021 Received in revised form 9 October 2021 Accepted 11 October 2021 Available online 23 October 2021 Keywords: Coronavirus disease 2019 metformin hospitalisation Along with antidiabetic effects, metformin has anti-infective and anti-inflammatory properties [1]. We [2] and others [3] have showed that metformin treatment is associated with better outcomes in diabetic patients hospitalised for coronavirus disease 2019 (COVID-19). However, it is not known whether this beneficial association is due to metformin treatment prior to hospital admission, its continuation during the hospital stay, or both. Here, we assessed differences in outcomes for patients who continued to take metformin in hospital versus those who did not. We also studied the correlations between blood levels of metformin and common inflammatory markers. The study population and methods have been described elsewhere [4]. Briefly, we collected data on consecutive diabetic patients admitted to Amiens University Hospital (Amiens, France) with PCRconfirmed COVID-19 between the start of the outbreak in France and May 23rd, 2020 (n = 145). We recorded each patient’s baseline characteristics, medications, laboratory results, and COVID-19 outcomes. Medical and prescription records were screened for metformin prescription / administration during the hospital stay. Plasma and erythrocyte metformin levels were analysed in a subset of the patients (n = 25), according to a previously described method [5]. All the patients were followed up until discharge or death. Patients were categorised into “continuation of metformin throughout the hospital stay”, “discontinuation of metformin on tologie et Nutrition, * Corresponding author at: Service d’Endocrinologie, Diabe ^ pital Nord, CHU Amiens-Picardie, Amiens, F-80054 cedex 01, France. Ho E-mail addresses: (A. Al-Salameh), (J.-D. Lalau). 1262-3636/© 2021 Elsevier Masson SAS. All rights reserved. admission”, and “no metformin” groups. Between-group comparisons were performed with the Mann−Whitney−Wilcoxon test (for two groups) or the Kruskal−Wallis test (for more than two groups) for numerical variables and Fisher’s exact test for categorical variables. The association between these groups and the primary endpoint (a composite of intensive care unit admission or death) was probed in a logistic regression analysis. The secondary endpoints were the components of the primary endpoint, the need for mechanical ventilation and a..
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