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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Mortality 16% Improvement Relative Risk Mortality (b) 22% ICU admission 22% Hospitalization 3% Mortality (c) 8% Mortality (d) 16% ICU admission (b) 39% Hospitalization (b) -2% Metformin  Ojeda-Fernández et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? PSM retrospective 13,112 patients in Italy Lower mortality (p<0.0001) and ICU admission (p=0.013) c19early.org Ojeda-Fernández et al., Diabetes, Obes.., Jan 2022 Favors metformin Favors control

Metformin use is associated with a decrease in risk of hospitalization and mortality in COVID-19 diabetic patients: a population-based study in Lombardy

Ojeda-Fernández et al., Diabetes, Obesity and Metabolism, doi:10.1111/dom.14648
Jan 2022  
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Metformin for COVID-19
3rd treatment shown to reduce risk in July 2020
 
*, now known with p < 0.00000000001 from 89 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. c19early.org
Retrospective 31,966 COVID+ patients using anti-hyperglycemic drugs in Italy, showing lower mortality and ICU admission with metformin use.
risk of death, 16.2% lower, RR 0.84, p < 0.001, treatment 1,476 of 6,556 (22.5%), control 1,787 of 6,556 (27.3%), NNT 21, odds ratio converted to relative risk, propensity score matching.
risk of death, 22.1% lower, RR 0.78, p < 0.001, treatment 968 of 6,556 (14.8%), control 1,261 of 6,556 (19.2%), NNT 22, odds ratio converted to relative risk, in-hospital mortality, propensity score matching.
risk of ICU admission, 22.4% lower, RR 0.78, p = 0.01, treatment 166 of 6,556 (2.5%), control 212 of 6,556 (3.2%), NNT 143, odds ratio converted to relative risk, propensity score matching.
risk of hospitalization, 2.7% lower, RR 0.97, p = 0.11, treatment 3,551 of 6,556 (54.2%), control 3,670 of 6,556 (56.0%), NNT 55, odds ratio converted to relative risk, propensity score matching.
risk of death, 8.3% lower, RR 0.92, p = 0.06, treatment 793 of 3,297 (24.1%), control 876 of 3,297 (26.6%), NNT 40, odds ratio converted to relative risk, excluding patients previously treated with insulin, propensity score matching.
risk of death, 16.0% lower, RR 0.84, p = 0.003, treatment 512 of 3,297 (15.5%), control 618 of 3,297 (18.7%), NNT 31, odds ratio converted to relative risk, excluding patients previously treated with insulin, in-hospital mortality, propensity score matching.
risk of ICU admission, 39.2% lower, RR 0.61, p = 0.002, treatment 64 of 3,297 (1.9%), control 102 of 3,297 (3.1%), NNT 87, odds ratio converted to relative risk, excluding patients previously treated with insulin, propensity score matching.
risk of hospitalization, 2.2% higher, RR 1.02, p = 0.36, treatment 1,822 of 3,297 (55.3%), control 1,792 of 3,297 (54.4%), odds ratio converted to relative risk, excluding patients previously treated with insulin, propensity score matching.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ojeda-Fernández et al., 10 Jan 2022, retrospective, Italy, peer-reviewed, 11 authors. Contact: luisa.ojeda@marionegri.it.
This PaperMetforminAll
Metformin use is associated with a decrease in the risk of hospitalization and mortality in COVID ‐19 patients with diabetes: A population‐based study in Lombardy
Luisa Ojeda‐fernández, MSc Andreana Foresta, MSc Giulia Macaluso, MSc Pierluca Colacioppo, MSc Mauro Tettamanti, Antonella Zambon, MD Stefano Genovese, MSc Ida Fortino, MSc Olivia Leoni, MSc Maria Carla Roncaglioni, Marta Baviera
Diabetes, Obesity and Metabolism, doi:10.1111/dom.14648
Aims. We compared the association of metformin use and COVID-19 outcomes in a cohort of 31,966 patients with diabetes in Lombardy. Methods. We used a COVID-19 linkable administrative regional database to select diabetic patients over 40 years old. They had at least two prescriptions of antidiabetic drugs in 2019 and a positive test for SARS-CoV-2 between 15 February 2020 and 15 March 2021. The association of metformin use and clinical outcomes was assessed by multivariable logistic regression analyses and after propensity score matching. Clinical outcomes were all-cause mortality, in-hospital mortality, hospitalization for COVID-19 and admission to an intensive care unit (ICU). Results. In multivariable models metformin use was associated with a significantly lower risk of total mortality (OR 0.70; 95% CI 0.66-0.75), in-hospital mortality (OR 0.68; 95% CI 0.63-0.73), hospitalization for COVID-19 (OR 0.86; 95% CI 0.81-0.91) and ICU admission (OR 0.81; 95% CI 0.69-0.94) compared with metformin non-users. Results were similar in propensity score analysis; metformin was associated with significantly lower risk of total mortality (OR 0.79; 95% CI, 0.73-0.86), in-hospital mortality (OR 0.74; 95% CI, 0.67-0.81) and ICU admission (OR 0.77; 95% CI, 0.63-0.95). Conclusions. In this large cohort, metformin use was associated with a protective effect in COVID-19 clinical outcomes, suggesting that it might be a potentially useful drug to prevent severe COVID-19 disease, although randomized clinical trials (RCT) are needed to confirm this. While awaiting the results of RCT, we suggest continuing prescribing metformin to diabetic patients with COVID-19.
part by confounding by indication, because metformin is used early in the trajectory of T2DM whereas insulin is typically started later. 28, 29 To minimize the effect of bias by indication, in a sensitivity analysis we excluded patients treated with insulin before and after PSM, substantially confirming result of the main analysis. Conclusions 1. Our results show that metformin use is associated with a lower risk of total and in-hospital mortality and with a good prognosis in patients with diabetes and COVID-19 compared to metformin non-users. 2. Since metformin is an inexpensive and well-tolerated drug, it is suitable for investigating the effectiveness in COVID-19 patients in randomized clinical trials (RCT) to overcome the limits of observational studies. 3. While awaiting results from RCT, we suggest continuing prescribing this drug. CONFLICT OF INTEREST All authors declare no conflict of interest
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