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0 0.5 1 1.5 2+ Mortality 22% Improvement Relative Risk Death/intubation 18% primary Ventilation 7% Metformin for COVID-19  Lalau et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? PSM retrospective 1,090 patients in France (March - April 2020) Lower mortality (p=0.16) and death/intubation (p=0.21), not sig. Lalau et al., Diabetes & Metabolism, Dec 2020 Favors metformin Favors control

Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19

Lalau et al., Diabetes & Metabolism, doi:10.1016/j.diabet.2020.101216
Dec 2020  
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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 2,449 hospitalized COVID-19 diabetes patients in France, 1,496 with existing metformin use, showing lower mortality with treatment. Statistical significance was reached in model 1 but not in models 2-4 which also adjust for HbA1c, eGFR, and diabetes duration, but have a lower number of patients. CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes).
risk of death, 22.2% lower, OR 0.78, p = 0.16, treatment 671, control 419, day 28, model 2, propensity score matching, RR approximated with OR.
risk of death/intubation, 17.8% lower, OR 0.82, p = 0.21, treatment 671, control 419, day 28, model 2, propensity score matching, primary outcome, RR approximated with OR.
risk of mechanical ventilation, 6.8% lower, OR 0.93, p = 0.72, treatment 671, control 419, day 28, model 2, propensity score matching, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lalau et al., 10 Dec 2020, retrospective, France, peer-reviewed, 33 authors, study period 10 March, 2020 - 10 April, 2020.
This PaperMetforminAll
Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19
Jean-Daniel Lalau, Abdallah Al-Salameh, Samy Hadjadj, Thomas Goronflot, Nicolas Wiernsperger, Matthieu Pichelin, Ingrid Allix, Coralie Amadou, Olivier Bourron, Thierry Duriez, Jean-François Gautier, Anne Dutour, Céline Gonfroy, Didier Gouet, Michael Joubert, Ingrid Julier, Etienne Larger, Lucien Marchand, Michel Marre, Laurent Meyer, Frédérique Olivier, Gaëtan Prevost, Pascale Quiniou, Christelle Raffaitin-Cardin, Ronan Roussel, Pierre-Jean Saulnier, Dominique Seret-Begue, Charles Thivolet, Camille Vatier, Rachel Desailloud, Matthieu Wargny, Pierre Gourdy, Bertrand Cariou
Diabetes & Metabolism, doi:10.1016/j.diabet.2020.101216
Metformin exerts anti-inflammatory and immunosuppressive effects. We addressed the impact of prior metformin use on prognosis in patients with type 2 diabetes hospitalised for COVID-19. Methods. -CORONADO is a nationwide observational study that included patients with diabetes hospitalised for COVID-19 between March 10 and April 10, 2020 in 68 French centres. The primary outcome combined tracheal intubation and/or death within 7 days of admission. A Kaplan-Meier survival curve was reported for death up to day 28. The association between metformin use and outcomes was then estimated in a logistic regression analysis after applying a propensity score inverse probability of treatment weighting approach. Results. -Among the 2449 patients included, 1496 were metformin users and 953 were not. Compared with non-users, metformin users were younger with a lower prevalence of diabetic complications, but had more severe features of COVID-19 on admission. The primary endpoint occurred in 28.0% of metformin users (vs 29.0% in non-users, P = 0.6134) on day 7 and in 32.6% (vs 38.7%, P = 0.0023) on day 28. The mortality rate was lower in metformin users on day 7 (8.2 vs 16.1%, P < 0.0001) and on day 28 (16.0 vs 28.6%, P < 0.0001). After propensity score weighting was applied, the odds ratios for primary outcome and death (OR [95%CI], metformin users vs non-users) were 0.838 [0.649À1.082] and 0.688 [0.470À1.007] on day 7, then 0.783 [0.615À0.996] and 0.710 [0.537À0.938] on day 28, respectively. Conclusion. -Metformin use appeared to be associated with a lower risk of death in patients with diabetes hospitalised for COVID-19.
Conflict of interest JDL reports personal fees from AstraZeneca, Brothier, Lilly, MSD, Novo Nordisk, Pfizer, and Sanofi. AAS reports personal fees from AstraZeneca and Novo Nordisk. SH reports personal fees and non-financial support from AstraZeneca, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, grants from Dinno Sante ´, personal fees from Eli Lilly, non-financial support from LVL, personal fees and non-financial support from MSD, personal fees from Novartis, grants from Pierre Fabre Sante ´, personal fees and non-financial support from Sanofi, personal fees and non-financial support from Servier, and personal fees from Valbiotis. MP reports personal fees and non-financial support from Novo Nordisk, nonfinancial support from Sanofi, and non-financial support from Amgen. JFG reports personal fees and non-financial support from Eli Lilly, personal fees and non-financial support from Novo Nordisk, personal fees and non-financial support from Gilead, and personal fees and non-financial support from AstraZeneca. MJ reports personal fees and non-financial support from Sanofi, personal fees and non-financial support from Eli Lilly, personal fees and non-financial support from Novo Nordisk, grants and personal fees from Boehringer Ingelheim, grants, personal fees and non-financial support from Medtronic, personal fees and non-financial support from Abbott, personal fees and non-financial support from BMS, personal fees and non-financial support from..
Ac (african Or Caribbean, As, HbA1c corresponds to the glycated haemoglobin determined in the first 7 days following hospital admission or in the 6 months prior hospitalisation
Arb, angiotensin-2 receptor-blocker
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Mra, mineralocorticoid-receptor antagonist (i.e. spironolactone and eplerenone)
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