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0 0.5 1 1.5 2+ Mortality 25% Improvement Relative Risk Metformin for COVID-19  Scheen et al.  META ANALYSIS Favors metformin Favors control

Metformin and COVID-19: From cellular mechanisms to reduced mortality

Scheen, A., Diabetes & Metabolism, doi:10.1016/j.diabet.2020.07.006
Nov 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 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.
Meta analysis of 4 observational studies with a total of 10,508 patients showing 25% lower mortality with metformin treatment in type 2 diabetes patients hospitalized for COVID-19.
22 meta analyses show significant improvements with metformin for mortality Chen, Ganesh, Han, Hariyanto, Kan, Kow, Li, Lukito, Ma, Nassar, Nguyen, Oscanoa, Parveen, Petrelli, Poly, Scheen, Schlesinger, Song, Sun, Yang, Zhan, hospitalization Li, Song, progression Yang, and severity Petrelli, Schlesinger, Song.
Currently there are 89 metformin for COVID-19 studies, showing 34% lower mortality [29‑39%], 33% lower ventilation [17‑46%], 16% lower ICU admission [6‑25%], 18% lower hospitalization [11‑24%], and 5% fewer cases [-4‑13%].
risk of death, 25.0% lower, OR 0.75, p < 0.001, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Scheen et al., 30 Nov 2020, peer-reviewed, 1 author. Contact:
This PaperMetforminAll
Abstract: Diabetes & Metabolism 46 (2020) 423–426 Available online at ScienceDirect Mini Review Metformin and COVID-19: From cellular mechanisms to reduced mortality A.J. Scheen Division of Diabetes, Nutrition and Metabolic Disorders, CHU Liège, and Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), Liège University, Liège, Belgium A R T I C L E I N F O A B S T R A C T Article history: Received 8 July 2020 Accepted 12 July 2020 Available online 1 August 2020 Type 2 diabetes mellitus (T2DM) is associated with both poorer clinical outcomes during the COVID-19 pandemic and an increased risk of death in such hospitalized patients. While the role of glucose control has been emphasized to improve the prognosis, the impact of different glucose-lowering agents remains largely unknown. Metformin remains the first-line pharmacological choice for the management of hyperglycaemia in T2DM. Because metformin exerts various effects beyond its glucose-lowering action, among which are anti-inflammatory effects, it may be speculated that this biguanide might positively influence the prognosis of patients with T2DM hospitalized for COVID-19. The present concise review summarizes the available data from observational retrospective studies that have shown a reduction in mortality in metformin users compared with non-users, and briefly discusses the potential underlying mechanisms that might perhaps explain this favourable impact. However, given the potential confounders inherently found in observational studies, caution is required before drawing any firm conclusions in the absence of randomized controlled trials. C 2020 Elsevier Masson SAS. All rights reserved. Keywords: Inflammation Meta-analysis Metformin Mortality SARS-CoV-2 Type 2 diabetes
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