Effect of Metformin on the Risk of Post-coronavirus Disease 2019 Condition Among Individuals With Overweight or Obese: A Population-based Retrospective Cohort Study
Ubonphan Chaichana, Kenneth K C Man, Chengsheng Ju, Janine Makaronidis, Li Wei
doi:10.1093/cid/ciaf429/8244943
Background. A subgroup analysis of the COVID-OUT trial's long-term outcome found that starting metformin within 3 days of coronavirus disease 2019 diagnosis reduced post-COVID-19 condition (PCC) incidence by 63% in overweight or obese individuals. However, its generalizability remains uncertain. Objectives. To evaluate the effectiveness of metformin in preventing PCC in adults with overweight or obesity who had a recent COVID-19 infection. Design. A retrospective cohort study using a sequential target trial emulation framework. Data Sources. The United Kingdom primary care data from the Clinical Practice Research Datalink Aurum database from March 2020 to July 2023. Participants. Adults with overweight or obesity (body mass index ≥ 25 kg/m²) and a record of severe acute respiratory syndrome coronavirus 2 infection were included. Exclusions included metformin use in the prior year or metformin contraindications. Measurements. The outcome was PCC, defined by a PCC diagnostic code or at least 1 World Health Organization-listed symptoms between 90 and 365 days after diagnosis, with no prior history of the symptom within 180 days before infection. The pooled hazard ratio and risk difference for the incidence of PCC were adjust for baseline characteristics. Results. Among 624 308 patients, 2976 initiated metformin within 90 days of COVID-19 diagnosis. The 1-year risk difference for PCC in the intention-to-treat analysis was -12.58% (hazard ratio 0.36; 95% CI, 0.32-0.41), with consistent results in subgroup analyses. Limitations. Findings may not apply to individuals with a normal body mass index. Conclusions. Early metformin treatment in overweight or obese individuals may reduce PCC risk. Further research is needed to confirm causality and clarify metformin's role in PCC management.
Supplementary Data Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author. Author Contributions. U. C. conceived the study and wrote the first draft of the manuscript. U. C. and C. J. carried out the statistical analysis, interpreted the data, and reviewed and edited the manuscript. L. W. and K. M. were involved in study concept, supervised the study, reviewed and edited the manuscript, and are the guarantors. J. M. reviewed and provided critical feedback on clinician's viewpoint. The all authors approved the final version for submission and agreed to be accountable for all aspects of this work. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Data sharing. This study is based on data from the CPRD, obtained under license from the UK MHRA. The data are not publicly available and can only be accessed by approved researchers who have obtained the necessary permissions from CPRD. Access to CPRD data requires a protocol submission and approval by the Independent Scientific Advisory Committee (ISAC). The authors do not have permission to share the data.
References
Aiyegbusi, Hughes, Turner, Symptoms, complications and management of long COVID: a review, J R Soc Med
Boglione, Meli, Poletti, Risk factors and incidence of long-COVID syndrome in hospitalized patients: does remdesivir have a protective effect, Qjm
Bonet, Vélez, Jordà, Treatment of COVID-19 during the acute phase in hospitalized patients decreases post-acute sequelae of COVID-19, J Clin Med
Bramante, Beckman, Mehta, Favorable antiviral effect of metformin on SARS-CoV-2 viral load in a randomized, placebo-controlled clinical trial of COVID-19, Clin Infect Dis
Bramante, Buse, Liebovitz, Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial, Lancet Infect Dis
Bramante, Ingraham, Murray, Metformin and risk of mortality in patients hospitalised with COVID-19: a retrospective cohort analysis, Lancet Healthy Longev
Català, Mercadé-Besora, Kolde, The effectiveness of COVID-19 vaccines to prevent long COVID symptoms: staggered cohort study of data from the UK, Spain, and Estonia, Lancet Respir Med
Chaichana, Man, Chen, Definition of post-COVID-19 condition among published research studies, JAMA Netw Open
Chen, Guo, Qiu, Zhang, Deng et al., Immunomodulatory and antiviral activity of metformin and its potential implications in treating coronavirus disease 2019 and lung injury, Front Immunol
Davis, Mccorkell, Vogel, Topol, Long COVID: major findings, mechanisms and recommendations, Nat Rev Microbiol
Dickerman, García-Albéniz, Logan, Denaxas, Hernán, Evaluating metformin strategies for cancer prevention: a target trial emulation using electronic health records, Epidemiology
Elm, Altman, Egger, Pocock, Gøtzsche et al., The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies, Lancet
Elsayed, Aleppo, Aroda, Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2023, Diabetes Care
Erickson, Fenno, Barzilai, Metformin for treatment of acute COVID-19: systematic review of clinical trial data against SARS-CoV-2, Diabetes Care
Groff, Sun, Ssentongo, Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review, JAMA Network Open
Hanson, Abbafati, Aerts, Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021, JAMA
Hernán, Robins, Using big data to emulate a target trial when a randomized trial is not available, Am J Epidemiol
Hundal, Krssak, Dufour, Mechanism by which metformin reduces glucose production in type 2 diabetes, Diabetes
Johnson, Abedian, Stürmer, Prevalent metformin use in adults with diabetes and the incidence of long COVID: an EHR-based cohort study from the RECOVER program, Diabetes Care
Lamanna, Monami, Marchionni, Mannucci, Effect of metformin on cardiovascular events and mortality: a meta-analysis of randomized clinical trials, Diabetes Obes Metab
Li, Yang, Yan, Sun, Zeng et al., Metformin in patients with COVID-19: a systematic review and meta-analysis, Front Med
Lopez-Leon, Wegman-Ostrosky, Perelman, More than 50 long-term effects of COVID-19: a systematic review and meta-analysis, Sci Rep
Lv, Guo, Metformin and its benefits for barious diseases, Front Endocrinol
Ma, Krishnamurthy, Is metformin use associated with low mortality in patients with type 2 diabetes mellitus hospitalized for COVID-19? A multivariable and propensity score-adjusted meta-analysis, PLoS One
Mesquita, Spiazzi, Piccoli, Does metformin reduce the risk of cancer in obesity and diabetes? A systematic review and meta-analysis, Diabetes Obes Metab
Neven, Vervaet, Brand, Metformin prevents the development of severe chronic kidney disease and its associated mineral and bone disorder, Kidney Int
Notaro, Neto, The use of metformin in women with polycystic ovary syndrome: an updated review, J Assist Reprod Genet
Parthasarathy, Tandel, Siddiqui, Harshan, Metformin suppresses SARS-CoV-2 in cell culture, Virus Res
Poly, Islam, Li, Lin, Hsu et al., Metformin use is associated with decreased mortality in COVID-19 patients with diabetes: evidence from retrospective studies and biological mechanism, J Clin Med
Postler, Peng, Bhatt, Ghosh, Metformin selectively dampens the acute inflammatory response through an AMPK-dependent mechanism, Sci Rep
Subramanian, Nirantharakumar, Hughes, Symptoms and risk factors for long COVID in non-hospitalized adults, Nat Med
Tanne, COVID-19: US agency launches raft of clinical trials of treatments for long COVID, BMJ
Ventura-López, Cervantes-Luevano, Aguirre-Sánchez, Treatment with metformin glycinate reduces SARS-CoV-2 viral load: an in vitro model and randomized, double-blind, Phase IIb clinical trial, Biomed Pharmacother
Walker, Mackenna, Inglesby, Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELY, Br J Gen Pract
Xie, Choi, Al-Aly, Molnupiravir and risk of post-acute sequelae of COVID-19: cohort study, BMJ
DOI record:
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"abstract": "<jats:title>Abstract</jats:title>\n <jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>A subgroup analysis of the COVID-OUT trial's long-term outcome found that starting metformin within 3 days of coronavirus disease 2019 (COVID-19) diagnosis reduced post–COVID-19 condition (PCC) incidence by 63% in overweight or obese individuals. However, its generalizability remains uncertain.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Objectives</jats:title>\n <jats:p>To evaluate the effectiveness of metformin in preventing PCC in adults with overweight or obesity who had a recent COVID-19 infection.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Design</jats:title>\n <jats:p>A retrospective cohort study using a sequential target trial emulation framework.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Data Sources</jats:title>\n <jats:p>The United Kingdom primary care data from the Clinical Practice Research Datalink Aurum database from March 2020 to July 2023.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Participants</jats:title>\n <jats:p>Adults with overweight or obesity (body mass index ≥ 25 kg/m²) and a record of severe acute respiratory syndrome coronavirus 2 infection were included. Exclusions included metformin use in the prior year or metformin contraindications.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Measurements</jats:title>\n <jats:p>The outcome was PCC, defined by a PCC diagnostic code or at least 1 World Health Organization–listed symptoms between 90 and 365 days after diagnosis, with no prior history of the symptom within 180 days before infection. The pooled hazard ratio and risk difference for the incidence of PCC were adjust for baseline characteristics.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>Among 624 308 patients, 2976 initiated metformin within 90 days of COVID-19 diagnosis. The 1-year risk difference for PCC in the intention-to-treat analysis was −12.58% (hazard ratio 0.36; 95% CI, 0.32–0.41), with consistent results in subgroup analyses.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Limitations</jats:title>\n <jats:p>Findings may not apply to individuals with a normal body mass index.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>Early metformin treatment in overweight or obese individuals may reduce PCC risk. Further research is needed to confirm causality and clarify metformin's role in PCC management.</jats:p>\n </jats:sec>",
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