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0 0.5 1 1.5 2+ Mortality 74% Improvement Relative Risk Ventilation 79% ICU admission 63% Hospitalization time 5% Metformin  Shaseb et al.  LATE TREATMENT  RCT Is late treatment with metformin beneficial for COVID-19? RCT 189 patients in Iran (March - April 2020) Lower ventilation with metformin (p=0.048) Shaseb et al., Advanced Pharmaceutical.., Jul 2022 Favors metformin Favors control

Long and Short-term Metformin Consumption as a Potential Therapy to Prevent Complications of COVID-19

Shaseb et al., Advanced Pharmaceutical Bulletin, doi:10.34172/apb.2023.066, IRCT20160310026998N10
Jul 2022  
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RCT 189 hospitalized patients showing lower mortality, ICU admission, and intubation with metformin, statistically significant only for intubation. Treatment patients may have also taken metformin prior to admission. Authors note that patients receiving metformin prior to the study were not matched, and diabetes and hyperlipidemia differed between groups.
risk of death, 74.0% lower, OR 0.26, p = 0.06, treatment 85, control 104, RR approximated with OR.
risk of mechanical ventilation, 79.0% lower, OR 0.21, p = 0.048, treatment 85, control 104, RR approximated with OR.
risk of ICU admission, 63.0% lower, OR 0.37, p = 0.07, treatment 85, control 104, RR approximated with OR.
hospitalization time, 5.0% lower, relative time 0.95, p = 0.52, treatment 85, control 104.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Shaseb et al., 2 Jul 2022, Randomized Controlled Trial, Iran, peer-reviewed, 26 authors, study period 20 March, 2020 - 5 April, 2020, trial IRCT20160310026998N10.
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Long and Short-term Metformin Consumption as a Potential Therapy to Prevent Complications of COVID-19
Elnaz Shaseb, Saba Ghaffary, Alireza Garjani, Elnaz Zoghi, Nasrin Maleki Dizaji, Somaieh Soltani, Parvin Sarbakhsh, Mohammad Hossein Somi, Parya Valizadeh, Ali Taghizadieh, Masood Faghihdinevari, Mojtaba Varshochi, Behrooz Naghily, Zhinous Bayatmakoo, Parviz Saleh, Sepehr Taghizadeh, Mehdi Haghdoost, Hamid Owaysi, Fatemeh Ravanbakhsh Ghavghani, Mohammad Kazem Tarzamni, Rojin Moradi, Fateme Javan Ali Azar, Saeid Shabestari Khiabani, Ardavan Ghazanchaei, Sana Hamedani, Shahabeddin Hatefi
Advanced Pharmaceutical Bulletin, doi:10.34172/apb.2023.066
The aim of the study is to evaluate the effect of metformin in complication improvement of hospitalized patients with COVID-19. Methods: This was a randomized clinical trial that involved 189 patients with confirmed COVID-19 infection. Patients in the intervention group received metformin-500 mg twice daily. Patients who received metformin before admission were excluded from the control group. Patients who were discharged before taking at least 2000 mg of metformin were excluded from the study. Primary outcomes were vital signs, need for ICU admission, need for intubation, and mortality. Results: Data showed that patients with diabetes with previous metformin in their regimen had lower percentages of ICU admission and death in comparison with patients without diabetes (11.3% vs. 26.1% (P = 0.014) and 4.9% vs. 23.9% (P ≤ 0.001), respectively). Admission time characteristics were the same for both groups except for diabetes and hyperlipidemia, which were significantly different between the two groups. Observations of naproxen consumption on endpoints, duration of hospitalization, and the levels of spO 2 did not show any significant differences between the intervention and the control group. The adjusted OR for intubation in the intervention group versus the control group was 0.21 [95% CI, 0.04-0.99 (P = 0.047)]. Conclusion: In this trial, metformin consumption had no effect on mortality and ICU admission rates in non-diabetic patients. However, metformin improved COVID-19 complications in diabetic patients who had been receiving metformin prior to COVID-19 infection, and it significantly lowered the intubation rates.
Authors' Contribution Competing Interests The authors declare no financial or non-financial conflict of interests. Ethical Approval Full informed consent was obtained from the participants. The study was conducted under the Research Ethics Committee (REC) of Tabriz University of Medical sciences guidelines of good clinical practice under the authorization of the Ministry of Health and Medical Education and the Helsinki Declaration. The presented data are part of the preliminary results of a clinical trial that is registered with the Iranian Registry of Clinical Trials, number IRCT20160310026998N10 and the ethics code of IR.TBZMED. REC.1398.1309.
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Late treatment
is less effective
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