Metformin is associated with lower hospitalizations, mortality and severe coronavirus infection among elderly medicare minority patients in 8 states in USA

Ghany, Reyan; Palacio, Ana; Dawkins, Elissa; Chen, Gordon; McCarter, Daniel F; Forbes, Emancia; Chung, Brian Hon Yin; Tamariz, Leonardo

doi:10.1016/j.dsx.2021.02.022

Cited by 32 publications

(46 citation statements)

References 16 publications

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“…Among the 31 studies included, these, 23 studies related to metformin ( 11 , 12 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ), 13 studies related to DPP-4i ( 23 , 28 , 29 , 32 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ), 5 studies related to sulfonylurea or glinides ( 23 , 29 , 36 , 41 , 46 ), 5 studies related to SGLT-2i ( 23 , 29 , 36 , 41 , 42 ) and 4 study related to GLP-1RA ( 23 , 29 , 42 , 46 ). Some of these studies included multiple outcomes to different medications.…”

Section: Resultsmentioning

confidence: 99%

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Han

Sun

et al. 2022

Archives of Medical Research

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Background and Aims During the current Coronavirus Disease 2019 (COVID-19) pandemic, patients with diabetes face disproportionately more. This study was performed to clarify anti-inflammatory effects of anti-diabetic agents on COVID-19 in patients with diabetes. Methods and Results Relevant literature was searched on 15 databases up to November 14, 2020 and was updated on April 13, 2021. The pooled ORs along with 95% CIs were calculated to evaluate combined effects. 31 studies with 66,914 patients were included in qualitative and quantitative synthesis. Meta-analysis showed that metformin was associated with a statistically significant lower mortality (pooled OR = 0.62, 95% CI, 0.50–0.76, p = 0.000) and poor composite outcomes (pooled OR = 0.83, 95% CI, 0.71–0.97, p = 0.022) in diabetic patients with COVID-19. Significance of slight lower mortality remained in sulfonylurea/glinides (pooled OR = 0.93, 95% CI, 0.89–0.98, p = 0.004), but of poor composite outcomes was not (pooled OR = 1.48, 95% CI, 0.61–3.60, p = 0.384). Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were associated with statistically non-significant lower mortality (pooled OR = 0.95, 95% CI, 0.72–1.26, p = 0.739) or poor composite outcomes (pooled OR = 1.27, 95% CI, 0.91–1.77, p = 0.162) of COVID-19 in diabetic patients. Conclusion Metformin might be beneficial in decreasing mortality and poor composite outcomes in diabetic patients infected with SARS-CoV-2. DPP-4 inhibitors, sulfonylurea/glinides, SGLT-2 inhibitors, and GLP-1RA wouldn't seem to be adverse. There's insufficient evidence to conclude effects of other anti-diabetic agents. Limited by retrospective characteristics, with relative weak capability to verify causality, more prospective studies, especially RCTs are needed. Registration number: PROSPERO-CRD42020221951.

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Section: Resultsmentioning

confidence: 99%

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Han

Sun

et al. 2022

Archives of Medical Research

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“…It has also been suggested that the immunomodulatory and immunometabolic effects of MET provide benefits in the treatment of patients with type 2 diabetes and insulin resistance during Covid-19 disease Hashemi and Pezeshki, 2021;O'Carroll and O'Neill, 2021). Retrospective studies have suggested a relative survival benefit in SARS-CoV-2 infected elderly persons taking MET compared to those not taking MET (Luo P. et al, 2020, p. 19;Ghany et al, 2021;Lally et al, 2021, p. 2).…”

Section: Lipid-lowering Drugs For Other Viral Infectionsmentioning

confidence: 99%

Anti-flavivirus Properties of Lipid-Lowering Drugs

et al. 2021

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Although Flaviviruses such as dengue (DENV) and zika (ZIKV) virus are important human pathogens, an effective vaccine or antiviral treatment against them is not available. Hence, the search for new strategies to control flavivirus infections is essential. Several studies have shown that the host lipid metabolism could be an antiviral target because cholesterol and other lipids are required during the replicative cycle of different Flaviviridae family members. FDA-approved drugs with hypolipidemic effects could be an alternative for treating flavivirus infections. However, a better understanding of the regulation between host lipid metabolism and signaling pathways triggered during these infections is required. The metabolic pathways related to lipid metabolism modified during DENV and ZIKV infection are analyzed in this review. Additionally, the role of lipid-lowering drugs as safe host-targeted antivirals is discussed.

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“…After reviewing all the titles and abstracts, 205 were excluded. A total of 23 articles went for full-text review, and 16 articles finally met all inclusion criteria [7,8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] (Supplementary Figure S1).…”

Section: Literature Searchmentioning

confidence: 99%

“…On 31 December 2019, the first outbreak of coronavirus diseases-2019 (COVID- 19) started in Wuhan, China, and has since affected more than 220 countries worldwide [1]. There are no specific drugs against SARS-CoV-2 infection; however, several existing drugs have been used to manage the disease's severity [2].…”

Section: Introduction 1rationalementioning

confidence: 99%

Metformin Use Is Associated with Decreased Mortality in COVID-19 Patients with Diabetes: Evidence from Retrospective Studies and Biological Mechanism

Poly

Islam

et al. 2021

JCM

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Background and Aims: The coronavirus disease 2019 (COVID-19) increases hyperinflammatory state, leading to acute lung damage, hyperglycemia, vascular endothelial damage, and a higher mortality rate. Metformin is a first-line treatment for type 2 diabetes and is known to have anti-inflammatory and immunosuppressive effects. Previous studies have shown that metformin use is associated with decreased risk of mortality among patients with COVID-19; however, the results are still inconclusive. This study investigated the association between metformin and the risk of mortality among diabetes patients with COVID-19. Methods: Data were collected from online databases such as PubMed, EMBASE, Scopus, and Web of Science, and reference from the most relevant articles. The search and collection of relevant articles was carried out between 1 February 2020, and 20 June 2021. Two independent reviewers extracted information from selected studies. The random-effects model was used to estimate risk ratios (RRs), with a 95% confidence interval. Results: A total of 16 studies met all inclusion criteria. Diabetes patients given metformin had a significantly reduced risk of mortality ((RR 0.65; 95% CI: 0.54–0.80, p < 0.001, heterogeneity I2 = 75.88, Q = 62.20, and τ2 = 0.06, p < 0.001)) compared with those who were not given metformin. Subgroup analyses showed that the beneficial effect of metformin was higher in the patients from North America (RR 0.43; 95% CI: 0.26–0.72, p = 0.001, heterogeneity I2 = 85.57, Q = 34.65, τ2 = 0.31) than in patients from Europe (RR 0.67; 95% CI: 0.47–0.94, p = 0.02, heterogeneity I2 = 82.69, Q = 23.11, τ2 = 0.10) and Asia (RR 0.90; 95% CI: 0.43–1.86, p = 0.78, heterogeneity I2 = 64.12, Q = 11.15, τ2 = 0.40). Conclusion: This meta-analysis shows evidence that supports the theory that the use of metformin is associated with a decreased risk of mortality among diabetes patients with COVID-19. Randomized control trials with a higher number of participants are warranted to assess the effectiveness of metformin for reducing the mortality of COVID-19 patients.

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Metformin is associated with lower hospitalizations, mortality and severe coronavirus infection among elderly medicare minority patients in 8 states in USA

Cited by 32 publications

References 16 publications

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

Anti-flavivirus Properties of Lipid-Lowering Drugs

Metformin Use Is Associated with Decreased Mortality in COVID-19 Patients with Diabetes: Evidence from Retrospective Studies and Biological Mechanism

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