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0 0.5 1 1.5 2+ Mortality 52% Improvement Relative Risk Metformin for COVID-19  Lally et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 775 patients in the USA Lower mortality with metformin (p=0.0088) Lally et al., J. the American Medical .., Jan 2021 Favors metformin Favors control

Metformin is Associated with Decreased 30-Day Mortality Among Nursing Home Residents Infected with SARS-CoV2

Lally et al., Journal of the American Medical Directors Association, doi:10.1016/j.jamda.2020.10.031
Jan 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 87 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Retrospective 775 nursing home residents in the USA, showing lower mortality with existing metformin use.
risk of death, 52.0% lower, HR 0.48, p = 0.009, treatment 16 of 127 (12.6%), control 144 of 648 (22.2%), NNT 10, adjusted per study, multivariable regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lally et al., 31 Jan 2021, retrospective, USA, peer-reviewed, 6 authors.
This PaperMetforminAll
Metformin is Associated with Decreased 30-Day Mortality Among Nursing Home Residents Infected with SARS-CoV2
MD Michelle A Lally, MD Philip Tsoukas, MS a , Christopher W Halladay, Emily O'neill, MD Stefan Gravenstein, MD James L Rudolph
Journal of the American Medical Directors Association, doi:10.1016/j.jamda.2020.10.031
Objectives: The COVID-19 pandemic presents an urgent need to investigate whether existing drugs can enhance or even worsen prognosis; metformin, a known mammalian target of rapamycin (m-TOR) inhibitor, has been identified as a potential agent. We sought to evaluate mortality benefit among older persons infected with SARS-CoV-2 who were taking metformin as compared to those who were not. Design: Retrospective cohort study. Setting and Participants: 775 nursing home residents infected with SARS-CoV-2 who resided in one of the 134 Community Living Centers (CLCs) of the Veterans Health Administration (VHA) during March 1, 2020, to May 13, 2020, were included. Methods: Using a window of 14 days prior to SARS-CoV-2 testing, bar-coded medication administration records were examined for dispensing of medications for diabetes. The COVID-19einfected residents were divided into 4 groups: (1) residents administered metformin alone or in combination with other medications, (2) residents who used long-acting or daily insulin, (3) residents administered other diabetes medications, and (4) residents not administered diabetes medication, including individuals without diabetes and patients with untreated diabetes. Proportional hazard models adjusted for demographics, hemoglobin A1c, body mass index, and renal function. Results: Relative to those not receiving diabetes medications, residents taking metformin were at significantly reduced hazard of death [adjusted hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.28, 0.84] over the subsequent 30 days from COVID-19 diagnosis. There was no association with insulin (adjusted HR 0.99, 95% CI 0.60, 1.64) or other diabetes medications (adjusted HR 0.71, 95% CI 0.38, 1.32). Conclusions and Implications: Our data suggest a reduction in 30-day mortality following SARS-CoV-2 infection in residents who were on metformin-containing diabetes regimens. These findings suggest a relative survival benefit in nursing home residents on metformin, potentially through its mTOR inhibition effects. A prospective study should investigate the therapeutic benefits of metformin among persons with COVID-19. Published by Elsevier Inc. on behalf of AMDA e The Society for Post-Acute and Long-Term Care Medicine. On December 31, 2019, an unforeseen health crisis emerged in Wuhan City, China. The World Health Organization reported a series of 44 pneumonia cases, 1 related to a new beta-coronavirus, SARS-CoV-2. By January 20, 2020, this newly termed coronavirus disease 2019 (COVID-19) was detected in the United States. 2 With COVID-19's rapid worldwide spread came the quick recognition of the major threat posed to the geriatric population, particularly the comorbid and frail. 3 Severe COVID-19 can occur in the presence of multiple chronic illnesses and age-related immunosenescence 4 ; grouped living conditions of many older people, particularly those in facilities, further ML and PT contributed equally and have agreed to share first..
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