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0 0.5 1 1.5 2+ Hospitalization 3% Improvement Relative Risk Metformin for COVID-19  Sandhu et al.  Prophylaxis Is prophylaxis with metformin beneficial for COVID-19? Retrospective 3,974,272 patients in the USA (Jan - Dec 2020) Lower hospitalization with metformin (p=0.0042) Sandhu et al., PLOS ONE, March 2023 Favors metformin Favors control

Outpatient medications associated with protection from COVID-19 hospitalization

Sandhu et al., PLOS ONE, doi:10.1371/journal.pone.0282961
Mar 2023  
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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 3,974,272 COVID-19 patients in the USA, showing 3% lower risk of hospitalization with pre-existing metformin use.
risk of hospitalization, 2.8% lower, OR 0.97, p = 0.004, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sandhu et al., 31 Mar 2023, retrospective, USA, peer-reviewed, mean age 50.7, 7 authors, study period 1 January, 2020 - 31 December, 2020. Contact:
This PaperMetforminAll
Outpatient medications associated with protection from COVID-19 hospitalization
Harpal Singh Sandhu, Joshua Lambert, Zach Steckler, Lee Park, Arnold Stromberg, Julio Ramirez, Chi-Fu Jeffrey Yang
PLOS ONE, doi:10.1371/journal.pone.0282961
The COVID-19 pandemic remains the pre-eminent global health problem, and yet after more than three years there is still no prophylactic agent against the disease aside from vaccines. The objective of this study was to evaluate whether pre-existing, outpatient medications approved by the US Food and Drug Administration (FDA) reduce the risk of hospitalization due to COVID-19. This was a retrospective cohort study of patients from across the United States infected with COVID-19 in the year 2020. The main outcome was adjusted odds of hospitalization for COVID-19 amongst those positive for the infection. Outcomes were adjusted for known risk factors for severe disease. 3,974,272 patients aged 18 or older with a diagnosis of COVID-19 in 2020 met our inclusion criteria and were included in the analysis. Mean age was 50.7 (SD 18). Of this group, 290,348 patients (7.3%) were hospitalized due to COVID-19, similar to the CDC's reported estimate (7.5%). Four drugs showed protective effects against COVID-19 hospitalization: rosuvastatin (aOR 0.91, p = 0.00000024), empagliflozin-metformin (aOR 0.69, p = 0.003), metformin (aOR 0.97, p = 0.017), and enoxaparin (aOR 0.88, p = 0.0048). Several pre-existing medications for outpatient use may reduce severity of disease and protect against COVID-19 hospitalization. Well-designed clinical trials are needed to assess the efficacy of these agents in a therapeutic or prophylactic setting.
Supporting information S1 Appendix. A full list of all drugs evaluated in this study is included. (DOCX) Author Contributions
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