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0 0.5 1 1.5 2+ Mortality 47% Improvement Relative Risk Mortality (b) 24% Mortality (c) 85% Mortality (d) 76% Metformin for COVID-19  Ong et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 355 patients in Philippines (March - September 2020) Lower mortality with metformin (p=0.017) c19early.org Ong et al., J. the ASEAN Federation of.., Oct 2021 Favors metformin Favors control

Association Between Metformin Use and Mortality Among Patients with Type 2 Diabetes Mellitus Hospitalized for COVID-19 Infection

Ong et al., Journal of the ASEAN Federation of Endocrine Societies, doi:10.15605/jafes.036.02.20
Oct 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 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 355 diabetic hospitalized COVID-19 patients in the Philippines, showing lower mortality with metformin use.
risk of death, 46.8% lower, RR 0.53, p = 0.02, treatment 33 of 186 (17.7%), control 57 of 169 (33.7%), NNT 6.3, adjusted per study, odds ratio converted to relative risk, combined pre-existing and in-hospital use.
risk of death, 23.9% lower, RR 0.76, p = 0.16, treatment 28 of 109 (25.7%), control 57 of 169 (33.7%), NNT 12, odds ratio converted to relative risk, pre-existing use, unadjusted.
risk of death, 85.2% lower, RR 0.15, p = 0.002, treatment 2 of 40 (5.0%), control 57 of 169 (33.7%), NNT 3.5, odds ratio converted to relative risk, in-hospital use, unadjusted.
risk of death, 76.0% lower, RR 0.24, p = 0.005, treatment 3 of 37 (8.1%), control 57 of 169 (33.7%), NNT 3.9, odds ratio converted to relative risk, mixed pre-existing/in-hospital use, unadjusted.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ong et al., 30 Oct 2021, retrospective, Philippines, peer-reviewed, 6 authors, study period 1 March, 2020 - 30 September, 2020. Contact: anj0321ong@gmail.com.
This PaperMetforminAll
Association Between Metformin Use and Mortality Among Patients with Type 2 Diabetes Mellitus Hospitalized for COVID-19 Infection
MD Angeli Nicole Ong, Ceryl Cindy Tan, Maria Teresa Cañete, Bryan Albert Lim, Jeremyjones Robles
Journal of the ASEAN Federation of Endocrine Societies, doi:10.15605/jafes.036.02.20
Introduction. Metformin has known mechanistic benefits on COVID-19 infection due to its anti-inflammatory effects and its action on the ACE2 receptor. However, some physicians are reluctant to use it in hypoxemic patients due to potential lactic acidosis. The primary purpose of the study was to determine whether metformin use is associated with survival. We also wanted to determine whether there is a difference in outcomes in subcategories of metformin use, whether at home, in-hospital, or mixed home/in-hospital use. Objectives. This study aimed to determine an association between metformin use and mortality among patients with type 2 diabetes mellitus hospitalized for COVID-19 infection. Methodology. This was a cross-sectional analysis of data acquired from the COVID-19 database of two tertiary hospitals in Cebu from March 1, 2020, to September 30, 2020. Hospitalized adult Filipino patients with type 2 diabetes mellitus who tested positive for COVID-19 via RT-PCR were included and categorized as either metformin users or metformin non-users. Results. We included 355 patients with type 2 diabetes mellitus in the study, 186 (52.4%) were metformin users. They were further categorized into home metformin users (n=109, 30.7%), in-hospital metformin users (n=40, 11.3%), and mixed home/in-hospital metformin users (n=37, 10.4%). Metformin use was associated with a lower risk for mortality compared to non-users (p=0.001; OR=0.424). In-hospital and mixed home/in-hospital metformin users were associated with lower mortality odds than non-users (p=0.002; OR=0.103 and p=0.005; OR 0.173, respectively). The lower risk for mortality was noted in metformin, regardless of dosage, from 500 mg to 2 g daily (p=0.002). Daily dose between ≥1000 mg to <2000 mg was associated with the greatest benefit on mortality (p≤0.001; OR=0.252). The survival distributions between metformin users and non-users were statistically different, showing inequality in survival (χ2=5.67, p=0.017). Conclusion. Metformin was associated with a lower risk for mortality in persons with type 2 diabetes mellitus hospitalized for COVID-19 disease compared to non-users. Use of metformin in-hospital, and mixed home/in-hospital metformin use, was also associated with decreased risk for mortality. The greatest benefit seen was in those taking a daily dose of ≥1000 mg to <2000 mg.
Statement of Authorship All authors certified fulfillment of ICMJE authorship criteria. Author Disclosure The authors declared no conflict of interest. Funding Source None. APPENDIX Vol. 36 JAFES Send your paper to the publication pathway. Instructions to Authors at www.ASEAN-endocrinejournal.org. Authors are required to accomplish, sign and submit scanned copies of the JAFES Author Form consisting of: (1) Authorship Certification, that authors contributed substantially to the work, that the manuscript has been read and approved by all authors, and that the requirements for authorship have been met by each author; (2) the Author Declaration, that the article represents original material that is not being considered for publication or has not been published or accepted for publication elsewhere, that the article does not infringe or violate any copyrights or intellectual property rights, and that no references have been made to predatory/suspected predatory journals; (3) the Author Contribution Disclosure, which lists the specific contributions of authors; (4) the Author Publishing Agreement which retains author copyright, grants publishing and distribution rights to JAFES, and allows JAFES to apply and enforce an Attribution-Non-Commercial Creative Commons user license; and (5) the Conversion to Visual Abstracts (*optional for original articles only) to improve dissemination to practitioners and lay readers Authors are also required to accomplish, sign, and submit..
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