c19early.org COVID-19 treatment researchCOVID-19 treatments

Metformin Use in Patients Hospitalized With COVID-19: Lower Inflammation, Oxidative Stress, and Thrombotic Risk Markers and Better Clinical Outcomes

Bliden et al., Circulation, 144:A12228, Nov 2021
ProphylaxisRetrospective · 75 patients · USA
Metformin for COVID-19
Bliden et al. Circulation, 144:A12228 · November 2021
Outcome
Improvement
Relative Risk · 95% CI
Mortality
60%0.40 · 0.12–1.37
Ventilation
76%0.24 · 0.06–1.03
00.511.52+
← Metformin
reduces riskMetformin
increases risk →
Lower mortality and ventilation
Not statistically significant · p = 0.21 (mortality) and p = 0.054 (ventilation)

Metformin for COVID-19

3rd treatment shown to reduce risk in July 2020, now with p < 0.0000000001 from 114 studies.
Lower risk for mortality, ventilation, ICU, hospitalization, progression, recovery, and viral clearance.

No treatment is 100% effective.
Protocols combine treatments.

6,700+ studies · 220+ treatments

c19early.org
Meta-analysis
Retrospective 75 diabetes patients, 34 on metformin, showing lower mortality with treatment in unadjusted results with minimal group details.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments. This may explain in part the very high mortality seen in this study. Results may differ in countries with improved SOC.
This study is excluded in the after exclusion results of meta-analysis: unadjusted results with minimal group details.
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OutcomeImprovementEffect · pTreatmentControl
risk of death 59.8% lower · RR 0.40 · p = 0.21 59.8% lowerRR 0.40p = 0.21 3 of 34 (8.8%) 9 of 41 (22.0%) treatment 3 of 34 (8.8%), control 9 of 41 (22.0%)NNT 7.6
risk of mechanical ventilation 75.9% lower · RR 0.24 · p = 0.05 75.9% lowerRR 0.24p = 0.05 2 of 34 (5.9%) 10 of 41 (24.4%) treatment 2 of 34 (5.9%), control 10 of 41 (24.4%)NNT 5.4

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates.

Bliden et al., 8 Nov 2021, retrospective, USA, preprint, 9 authors.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2026 USA Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines Vietnam Japan Argentina Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Bosnia-Herzegovina Jordan Georgia Switzerland Dominican Republic Bolivia Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Iceland New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel Haiti North Macedonia Hong Kong Qatar Panama Serbia USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2026 USA Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines Vietnam Japan Argentina Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Taiwan Fiji Zambia Jordan Georgia Switzerland Dominican Rep. Bolivia Côte d'Ivoire Eritrea Togo Sri Lanka Bulgaria Greece Slovakia New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%