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Outpatient metformin use is associated with reduced severity of COVID‐19 disease in adults with overweight or obesity

Bramante et al., Journal of Medical Virology, doi:10.1002/jmv.26873
Mar 2021  
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Mortality, PSM 62% Improvement Relative Risk Mortality, MV 68% ICU admission, PSM -9% ICU admission, MV 32% Hospitalization, MV 22% Metformin for COVID-19  Bramante et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 9,555 patients in the USA (March - December 2020) Lower mortality with metformin (p=0.029) c19early.org Bramante et al., J. Medical Virology, Mar 2021 Favorsmetformin Favorscontrol 0 0.5 1 1.5 2+
Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020, now with p < 0.00000000001 from 99 studies.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 112 treatments. c19early.org
Retrospective 17,396 PCR+ patients in the USA, showing lower mortality with metformin use.
risk of death, 62.0% lower, OR 0.38, p = 0.03, treatment 342, control 342, propensity score matching, RR approximated with OR.
risk of death, 68.0% lower, OR 0.32, p = 0.003, treatment 676, control 8,879, adjusted per study, multivariable, RR approximated with OR.
risk of ICU admission, 9.0% higher, OR 1.09, p = 0.78, treatment 342, control 342, propensity score matching, RR approximated with OR.
risk of ICU admission, 32.0% lower, OR 0.68, p = 0.06, treatment 676, control 8,879, adjusted per study, multivariable, RR approximated with OR.
risk of hospitalization, 22.0% lower, OR 0.78, p = 0.10, treatment 676, control 8,879, adjusted per study, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bramante et al., 23 Mar 2021, retrospective, USA, peer-reviewed, 18 authors, study period 4 March, 2020 - 4 December, 2020. Contact: bramante@umn.edu.
This PaperMetforminAll
Outpatient metformin use is associated with reduced severity of COVID‐19 disease in adults with overweight or obesity
MD, MPH Carolyn T Bramante, MD John Buse, MD Leonardo Tamaritz, MD Ana Palacio, MD Ken Cohen, Deneen Vojta, MD David Liebovitz, MD, MPH Nia Mitchell, MD Jacinda Nicklas, MD, MPH, MSCS Ildiko Lingvay, MD, MPH Jeanne M Clark, Louis J Aronne, MD, MPH Erik Anderson, Michael Usher, PhD, MPH Ryan Demmer, MD Genevieve B Melton, MD Nicholas Ingraham, Christopher J Tignanelli
Journal of Medical Virology, doi:10.1002/jmv.26873
Observational studies suggest outpatient metformin use is associated with reduced mortality from coronavirus disease-2019 (COVID-19). Metformin is known to decrease interleukin-6 and tumor-necrosis factor-α, which appear to contribute to morbidity in COVID-19. We sought to understand whether outpatient metformin use was associated with reduced odds of severe COVID-19 disease in a large US healthcare data set. Retrospective cohort analysis of electronic health record (EHR) data that was pooled across This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
AUTHOR CONTRIBUTIONS Dr. Tignanelli is the guarantor with responsibility for the work as a whole given his full access to the data. Carolyn T. Bramante Michael Usher contributed to design and analysis. Ryan Demmer contributed to design, analysis, and critical review. Genevieve B. Melton contributed to design and analysis and writing. Nicholas Ingraham contributed to analysis and writing. Christopher J. Tignanelli contributed to study design, analysis, interpretation, and critical review. SUPPORTING INFORMATION Additional Supporting Information may be found online in the supporting information tab for this article.
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